Symptoms

Morphea is a form of scleroderma, a term that literally means "hard skin." Symptoms of morphea include:

• Hardening of the skin.
• Thickening of the skin.
• Discoloration of the affected skin to look lighter or darker than the surrounding area. Most people develop one or two oval-shaped patches that start out red, purple (lilac-colored) or yellowish and gradually develop a whitish center. Over time the patches may turn a brownish color and eventually they may be an off-white color.

Morphea usually affects only the uppermost layers of your skin, which is known as superficial morphea. But, in some cases morphea may involve fatty or connective tissue below your skin. This is known as morphea profunda.

Morphea may be present all of the time (chronic), or it may come and go (recurrent). However, the condition generally lasts several years and then disappears on its own.

When to see a doctor
If you notice patches of discoloring, hardening or thickening skin, see your doctor. Early diagnosis and treatment may help slow the development of new patches, and allows your doctor to identify and treat complications before they progress.

Causes

The exact cause of morphea is unknown, though doctors do know it's not contagious. It's believed that an unusual reaction of the immune system plays a role in the development of this condition.

Possible associations with the onset of morphea include:

• Radiation therapy
• Repeated trauma to the affected area
• A recent infection, such as measles or chickenpox

Risk factors

Because the cause of morphea is unknown, it's difficult to pinpoint who may be at a higher risk. However, there are several known factors that may increase your risk of developing morphea, including:

• Sex. Morphea is more common in women than in men.
• Race. Whites and people of Asian descent are more likely to develop morphea than are blacks.

Complications

Morphea can cause a number of complications, including:

• Self-esteem issues. Morphea can have a negative effect on your self-esteem and body image, particularly if discolored patches of skin appear on your arms, legs or face. Though your skin will likely soften and become less obviously discolored over time, some discoloration may last for years.
• Movement problems. Morphea that affects the arms and legs can impair joint mobility. The pain may subside in the following months or years, even if discolored patches of skin remain.
• Widespread areas of hardened, discolored skin. Sometimes new patches of hard, discolored skin appear in such numbers that some may seem to join together. This more extensive condition is called generalized morphea.

Preparing for your appointment

You'll probably first bring up your symptoms with your primary care physician. However, he or she may then refer you to a doctor who specializes in skin disorders (dermatologist). You may also be referred to a doctor who treats autoimmune diseases (rheumatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins and supplements that you're taking.
• Write down questions to ask your doctor.

Preparing a list of questions can help you cover all of the points that are important to you. For morphea, some basic questions you might want to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• How long will these skin changes last?
• If the skin discoloration and hardening clears up, will it ever come back?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• I have other health conditions. How can I best manage these conditions together?
• What can I do to improve my appearance?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any additional questions that might come up during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first notice changes in your skin?
• Has this ever happened to you before?
• Do the changes come and go or are they constant?
• Have you tried to treat this condition yourself? If so, did it help?
• Have you ever been treated by a doctor for this condition?
• If so, what were the treatments and did they help?
• Have you had any difficulty chewing your food or swallowing?
• Have you experienced extreme cold sensitivity in your fingers or toes?
• Have you noticed any other changes in your general health that concern you?

Tests and diagnosis

A doctor may confirm a diagnosis of morphea based on:

• Physical examination. Discoloration combined with skin firmness is a good indicator of morphea. After inspecting your skin and discussing other signs and symptoms you may have, your doctor may recommend taking a tissue sample for analysis.
• Tissue sample. Your doctor may remove a small tissue sample (biopsy) of your affected skin to be examined in the laboratory for abnormalities that allow for diagnosis, such as thickening of the collagen in the second layer of skin (dermis). Collagen is a protein that makes up your connective tissues, including your skin. It helps make your skin elastic and resilient.

Treatment and drugs

Morphea has no known cure. Treatment of morphea focuses on controlling the signs and symptoms and slowing its spread.

Because morphea may get better on its own without treatment, and most treatments have side effects, your doctor may suggest no treatment or treatment with a mild topical corticosteroid cream. For more widespread morphea, or if your face is involved, your doctor may recommend additional treatments, such as:

• Calcipotriene cream (Dovonex). This treatment is a synthetic form of vitamin D that may help lessen the effects of morphea. Skin generally begins to improve during the first months of treatment. Possible side effects include burning, stinging and a rash.
• Light therapy. A special treatment that uses ultraviolet light may improve your skin's appearance, especially when used soon after skin changes appear.
• Corticosteroids. Your doctor may prescribe these medications early in the course of treatment, to reduce inflammation and prevent thickening of the collagen. They can be taken either orally or topically or in both forms. An increased risk of infection, high blood pressure, bone loss and fluid retention are possible side effects associated with the use of oral corticosteroids.
• Antimalarial drugs. Medications such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen) may help reduce inflammation and slow the progress of the disease. Potential side effects may include headache, dizziness, diarrhea and abdominal cramping.
• Immunosuppressive medications. Your doctor may prescribe drugs, such as methotrexate (Rheumatrex) or cyclosporine (Neoral, Gengraf, Sandimmune), to control your immune system and reduce inflammation. However, these medications can have serious side effects, including an increased risk of infections, kidney and liver problems, and high blood pressure.
• Physical therapy. This type of treatment uses stretching, strengthening and range-of-motion exercises to improve the mobility of your joints.

Lifestyle and home remedies

Because morphea dries out the affected skin, moisturizers may help soften and improve the feel of your skin. In addition, it's a good idea to avoid long hot showers or baths, as these can be very drying to your skin.

If you have morphea in more visible locations, makeup and other topical treatments may help to hide the condition and make your skin appear more natural.

Alternative medicine

Para-aminobenzoic acid (PABA) is an oral medication that has been used to treat morphea and scleroderma. However, it hasn't been proved to reduce skin symptoms in clinical trials. If you're interested in trying PABA, discuss its proper use with your doctor.

Coping and support

Because morphea affects your appearance, it can be an especially difficult condition to live with. In addition, you may also be concerned that it will get worse.

Talk with your doctor about your concerns regarding your appearance. He or she can suggest treatments that may help lessen your symptoms. Your doctor can also give you a referral to a psychiatrist or psychologist if you're interested in talking with a mental health professional. Or, your doctor may know if there are any scleroderma or morphea support groups in your area. Many people find that talking to others who are living with the same condition is very helpful and encouraging. If your doctor doesn't know of any groups, you can call the Scleroderma Foundation at 800-722-HOPE (800-722-4673) or visit its Web site.