Morphoea — SCE Dermatology MCQ

Correct answer: B — Emollients and monitoring — no active treatment needed for burnt-out morphoea

The correct answer is B, Emollients and monitoring, no active treatment needed for burnt-out morphoea. The absence of a lilac (violaceous) border shows the plaque has passed from the active, inflammatory phase into the inactive, sclerotic (burnt-out) phase, where fibrosis is established but there is no ongoing inflammatory drive to modify. Once a plaque has been clinically stable for a prolonged period (here, two years) with an ivory-white centre and no erythematous or lilac edge, immunosuppressive therapy will not reverse fixed fibrosis and only exposes the patient to unnecessary drug toxicity. Management therefore shifts to emollients for skin comfort and pliability, with monitoring (clinical photography, LoSCAT scoring) to detect any future reactivation, which would be signalled by a new lilac border or lesion expansion. Why the other options are wrong: D. Start systemic Methotrexate: reserved for active, progressive morphoea (a lilac inflammatory border, new lesions, or linear/generalised/deep subtypes), not for quiescent, burnt-out plaques with no inflammation to suppress. C. Start a biologic: biologics have no established role in localised, inactive morphoea and are not standard even in active disease, where methotrexate with corticosteroids remains first-line systemic therapy. A. Oral Prednisolone: systemic corticosteroids target active inflammatory morphoea to halt progression; a stable inactive plaque has no inflammation to treat, so steroid side effects are unjustified. E. Surgical excision: not indicated for uncomplicated plaque morphoea; excision or reconstructive procedures are occasionally used for functional deformity from burnt-out disease, not routinely for a stable asymptomatic trunk plaque. Key point: Treatment in morphoea is guided by disease activity, not lesion presence; a lilac border signals active disease needing systemic therapy, while a stable ivory-white plaque without this border needs only emollients and monitoring.

Reference: DermNet NZ, Morphoea (localised scleroderma), 2023 update: activity assessed by lilac/violaceous border indicating active inflammation versus ivory-white burnt-out plaques requiring only supportive care and monitoring. https://dermnetnz.org/topics/morphoea