Localized and systemic scleroderma show different histological responses to methotrexate therapy.
Although morphoea (localized scleroderma) and systemic sclerosis are distinct disease entities, the skin lesions show identical histological characteristics and both diseases respond favourably to low-dose treatment with methotrexate (MTX). The aim of this study was to find out whether MTX treatment induces different histological response patterns in these two diseases. In seven patients with morphoea and eight with systemic sclerosis, skin biopsies were taken before and after 24 weeks of treatment with low-dose MTX. In the centre and active margin of morphoea lesions, a significant reduction in tenascin staining was seen after 24 weeks of treatment, in contrast to systemic sclerosis. The numbers of mast cells decreased in the active margin of morphoea lesions, whereas in systemic sclerosis no significant change was seen after MTX therapy. Epidermal proliferation and staining of heparan sulphate proteoglycans showed no changes. Although skin lesions from both diseases respond clinically to treatment with MTX, systemic sclerosis shows no change in the immunohistochemical parameters investigated, whereas morphoea does. This difference in dynamic pattern suggests that the apparently similar lesions in localized and systemic sclerosis are not identical.
Department of Dermatology, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. M.Seijger@derma.azn.nl
M M
MM
Seyger
F H
FH
van den Hoogen
I M
IM
van Vlijmen-Willems
P C
PC
van de Kerkhof
E M
EM
de Jong
D000328:Adult; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000031:analogs & derivatives / Q000378:metabolism; D006801:Humans; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008407:Mast Cells / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011509:Proteoglycans / Q000378:metabolism; D012594:Scleroderma, Localized / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D019063:Tenascin / Q000378:metabolism; D016896:Treatment Outcome
D003879:Dermatologic Agents; D019394:Ki-67 Antigen; D011509:Proteoglycans; D019063:Tenascin; C036090:heparin proteoglycan; D006493:Heparin; D008727:Methotrexate