Morphea

00:01 Morphea.

00:02 Morphea means an unknown disease of the dermis, affects both children, and adults.

00:06 Just a couple of points here so that you know that you’ve heard of morphea at some point in time in your medical education.

00:12 Dermis.

00:13 Dermis is your pathology.

00:16 Classic shiny and atrophic plaque.

00:20 The clinical pearl here, shiny, classic.

00:23 Often with iliac-colored erythema of the periphery.

00:28 Over time, it becomes burnt out.

00:31 Skin becomes thickened and bound, and involvement across joints may yield contractures.

00:38 Morphea, involvement of the dermis, extremely shiny.

00:42 If you know that, you'll be in good shape.

00:44 It could affect both men and women with equal preponderance.

00:51 Morphea can occur in linear line on the forehead.

00:54 And this is then referred to as being “cut of the sword.” Morphea, dermis, shiny.

01:04 If you take a look at the breast of this individual, take a moment here to make sure that you are identifying where we are on the body.

01:12 Here, we have a female, and you’ll notice on the left that it's the breast that’s being involved.

01:18 As you move from your left to right, and I want you to focus on the right most picture here, look how shiny this is.

01:26 Literally, you look at the skin and it’s glistening.

01:30 You have the light, which is then reflecting off this shiny skin.

01:36 In morphea, my disease is where? It is in your dermis.

01:41 And because of the involvement of your dermis at some point in time, when it gets burned out, then you end up having perhaps any part of that area which is then going -- I want you to compare the picture on the left, and I want you to see as to how it’s contracted as you move to the right.

01:58 Is that clear? It’s almost like there is fibrosis taking place in which it’s causing contraction.

02:05 It almost looks like it’s telescoping.

02:10 Morphea.

02:11 What is my characteristic change? Well, we’ll take a look at a few.

02:15 Square biopsy edges, a thickened scar-like dermis.

02:21 Stop there.

02:21 Think about the picture that I just showed you on gross examination, where in which that skin looked very shiny.

02:28 And you have entrapment of sweat glands and other appendages by thick collagen bundles.

02:34 If you then take a look at the picture on the right, you’ll notice that there’s abundance of collagen which is then causing a scar-like formation.

02:41 And with this then happening, and you can imagine wherever this is taking place, for example, from the breast in the previous picture, then you’ll have the contraction taking place.

02:51 Management: For limited lesions, first-line therapies include topical corticosteroids.

02:57 For deep and more widespread lesions, the first-line therapy is to treat the lesions with systemic weekly methotrexate, followed by prednisolone.

03:05 Second-line therapy for resistant cases is oral hydroxychloroquine. Vitamin D derivatives are second-line treatments because their efficacy is supported by open-label clinical trials, not by RCTs.