Morphoea

Morphoea is a rare skin disorder/disease/complaint where areas of skin become much thicker and firmer than usual.  Morphoea usually affects a few small areas of the skin. Very rarely, it can occur over larger areas of the body in a form called ‘generalized morphoea.’

The cause of morphoea is unknown, but it is not contagious. It is not hereditary but seems to be more common in people with autoimmune complaints, and these can run in families.

The affected areas of skin become stiff because of the over-production of collagen fibers. These give the skin its normal strength and structure, so when excess collagen is made, the skin feels harder and more rigid than usual.

Morphoea usually starts without any apparent trigger, but it has been noted to happen after a skin injury such as an insect bite, a burn, or viral infections. It may start at any age, including childhood, and in adulthood, it is more common in women than men.

Morphoea usually appears as bruise-like pink patches of skin that thicken and turn pale and waxy in the middle, leaving a pink/ pale purple border. The skin feels firmer than usual when gently pinched. Sometimes the affected areas of skin turn slightly darker and beige colored. Hair is usually lost from the affected areas, and the sweat glands stop working, so the skin feels dry. 

In rare cases, fatty tissue and muscle under the morphoea disappear, so the skin becomes indented and stuck onto the underlying bone. The affected areas usually range from 2 to 15 cm in diameter and are oval in shape (like a thumbprint or palm print). This condition is called plaque morphoea.

In children, morphoea usually appears as a thickened strip of skin called ‘linear morphoea.’ This skin problem usually runs along part of the torso or a limb. It can also affect the forehead to the scalp and cause a grove in the skin with hair loss (sometimes referred to as ‘en coup de sabre’).

Morphoea usually develops slowly, and there may be few symptoms. The affected area(s) can be itchy, uncomfortable, or numb. When morphoea affects the skin on a limb or over a joint, it can restrict growth and mobility and, in severe cases, can cause long-term disability.

A dermatologist can usually diagnose morphea by examining the skin because it has a distinctive appearance. A skin biopsy (a small piece of the skin, removed under a local anesthetic) can be taken from the affected area if there is uncertainty or rule out other skin complaints. Blood tests may also be helpful.

Is there a cure for morphoea? There is no known cure for morphoea, and it typically lasts for several years, so it is considered a chronic skin disorder.

The treatment for morphoea depends on the type (linear, plaque, or generalized), the patient’s age, and whether it has spread underneath the skin. Plaque morphoea does not always need treatment because it usually improves on its own after a few years. However, strong steroid creams or ointments or a non-steroid cream such as Tacrolimus are sometimes used as they may relieve any irritation and stop the patches enlarging. Intralesional injections of steroids (into the affected skin) can also help.

Early treatment is vital for linear and generalized morphoea to prevent later problems, especially loss of mobility. Options include ultraviolet therapy / ‘PUVA’ oral or intravenous steroids and Methotrexate. In addition to care from a dermatologist, expert treatment may be needed from a plastic surgeon or orthopedic surgeon, rheumatologist, and physiotherapist.