Morphoea — SCE Dermatology MCQ

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ModerateConnective Tissue & VasculitisMorphoeaSCE Dermatology

A 35-year-old woman has widespread morphoea (generalised type). She has multiple indurated plaques with lilac-coloured active borders and central ivory-white sclerosis. What systemic treatment is recommended for active progressive morphoea?

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Correct answer: C — Combination of Methotrexate with pulsed IV Methylprednisolone

For active progressive morphoea (especially generalised, linear, or deep subtypes), BAD guidelines recommend systemic treatment with Methotrexate (0.3-0.6 mg/kg/week) combined with pulsed IV Methylprednisolone (initially to rapidly suppress inflammation). Oral Prednisolone can be used instead of IV pulses. The lilac ring at the plaque border indicates active inflammation amenable to treatment; ivory-white sclerosis indicates established fibrosis which is less reversible. UVA1 phototherapy (medium-dose) is an alternative for skin-limited disease. Topical therapy alone is insufficient for progressive generalised morphoea. Physiotherapy is important for joint-crossing lesions.

Reference: BAD 2018 Morphoea Guidelines; EULAR/PRES