Discordance of pediatric morphea treatment by pediatric dermatologists

Abstract

Background/Objectives: Studies describing treatment efficacy in pediatric morphea

A retrospective study: Impact of consensus treatment plans on systemic therapy of pediatric morphea

“…10 We only reviewed patients treated with systemic therapy, but may have seen a greater effect of publication of CTPs if we had compared how many patients were treated with topical monotherapy before and after publication, as previous studies have found that a significant proportion of dermatologists treat even linear morphea with only topical therapy. 24 Although not statistically significant, there was a decrease in the percentage of patients who were treated Our findings support that there was a standardization of treatment at our institution in treatment approach for patients with morphea requiring systemic therapy after the publication of the CTPs. In addition, our data showed a statistically significant shift in providers who were prescribing and recommending systemic treatment.…”

“…For example, we did not have patients treated with alternative systemic therapies such as antibiotics or antimalarials as reported in prior studies . We only reviewed patients treated with systemic therapy, but may have seen a greater effect of publication of CTPs if we had compared how many patients were treated with topical monotherapy before and after publication, as previous studies have found that a significant proportion of dermatologists treat even linear morphea with only topical therapy . Although not statistically significant, there was a decrease in the percentage of patients who were treated with topical therapy prior to systemic medication in the post‐CTP group.…”

Parry Romberg disease with En Coup de Sabre Scleroderma: Effect of tocilizumab on periodontal bone inflammation

“…1 Pediatric rheumatologists overwhelmingly chose systemic immunosuppression as first-line therapy while a survey of pediatric dermatologists in the United States reported that 37% considered topical agents as primary therapy or monotherapy for LS of the head or neck. 8 The choice of immunosuppressive agent usually follows consensus treatment plans for juvenile LS: MTX as first-line systemic treatment and MMF as second-line treatment in refractory cases. 2 It is known that IL-6 promotes fibrosis and its inhibition in animal models of systemic sclerosis retarded progression and decreased the severity of cutaneous fibrosis.…”

Differentiating Activity From Damage—The Morphological Challenge of Morphea

“…Moreover, early signs may be subtle, progression can be slow, and classic signs of disease damage can be prominent when morphea is still active. This complexity contributes to well-documented diagnostic discrepancies, treatment delays, and undertreatment . Unrecognized and untreated disease activity leads to accrual of permanent damage, correlating with poorer patient-reported quality of life (QoL) outcomes.…”

“…Hence, deep tissue extension is a marker of disease severity, requiring more aggressive treatment interventions . Yet physician uncertainty regarding the meaning of atrophy in morphea and the challenges of measuring atrophy can contribute to deep tissue involvement being overlooked . The MAM attempts to address this important conundrum by including progressive atrophy in the past 6 months for assessment of linear morphea.…”