title: A systematic review of morphea treatments and therapeutic algorithm.
abstract: BACKGROUND
  Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care.
  
  
  OBJECTIVE
  We sought to create an evidence-based therapeutic algorithm.
  
  
  METHODS
  We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized.
  
  
  RESULTS
  Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported.
  
  
  CONCLUSIONS
  Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures.
  
  
  CONCLUSIONS
  Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making.
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9069, USA.
authors.forename: Brittany A
authors.initials: BA
authors.lastname: Zwischenberger
authors.forename: Heidi T
authors.initials: HT
authors.lastname: Jacobe
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D011701:PUVA Therapy; D012594:Scleroderma, Localized / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D014467:Ultraviolet Therapy; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D014807:Vitamin D; C055085:calcipotriene; D002117:Calcitriol; D016559:Tacrolimus; D008727:Methotrexate