Differentiating Activity From Damage—The Morphological Challenge of Morphea

Abstract

Development of robust measures to monitor disease status and evaluate therapeutic impacts is central to improving patient outcomes. However, differentiating activity and damage in morphea is challenging. In this issue of JAMA Dermatology, García-Romero et al 1 report the development of the Morphea Activity Measure (MAM), an instrument designed to capture disease activity in pediatric morphea. Using Delphi consensus methods, 14 experts agreed on a 10-item tool. The final items were new lesions, enlarging lesions, progressive atrophy in linear lesions, erythema, violaceous rim, warmth, induration or edema, white-yellow or waxy appearance, shiny white wrinkling, and body surface area of active lesions at 7 body sites. The validity and reliability of the MAM were then tested by 8 of the original 14 experts in a cohort of 14 children with various morphea subtypes.

Responsiveness to Change of the Morphea Activity Measure in Pediatric Patients

“…Morphea (also called localized scleroderma) is a pleomorphic fibrosing disease with an active inflammatory phase that often resolves with permanent damage . Detecting active disease can be complex, as signs may be subtle, insidious, and variable according to location, morphologic features, and depth of involvement, causing treatment delays or undertreatment that leads to damage and functional impairment . Because of the difficulty in assessing morphea disease activity and the absence of a criterion standard for assessment, objective and inclusive outcome measures are necessary.…”

“…1 Detecting active disease can be complex, as signs may be subtle, insidious, and variable according to location, morphologic features, and depth of involvement, causing treatment delays or undertreatment that leads to damage and functional impairment. [2][3][4] Because of the difficulty in assessing morphea disease activity and the absence of a criterion standard for assessment, objective and inclusive outcome measures are necessary. The modified Localized Scleroderma Severity Index (mLoSSI) has historically been used for assessing morphea activity.…”