Treatment of Recalcitrant Generalized Morphea With Infliximab

Diab, Mohammad; Coloe, Jacquelyn; Magro, Cynthia M.; Bechtel, Mark

doi:10.1001/archdermatol.2010.120

Cited by 46 publications

(28 citation statements)

References 8 publications

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“…49,51 Although the evidence for using mycophenolate mofetil in the treatment of morphea is weak, 76 it has a more favorable side-effect profile than other systemic immunosuppressives supported by similarly weak data (cyclosporine, imitinib, D-penacilliamine, cyclosphosphamide, TNF-α inhibitors, or extracorporal photopheresis). [77][78][79][80][81][82][83] Mycophenolate mofetil has been shown to have antifibrotic properties in both in vitro and in vivo studies, [84][85][86][87][88][89][90] and open-label trials have revealed statistically significant improvement in skin scores in subjects with diffuse systemic sclerosis and improvement in retroperitoneal fibrosis. 87,90 Mycophenolate mofetil also has been agreed on as a second-line agent to methotrexate by the Childhood Arthritis and Rheumatology Research Alliance Localized Scleroderma Workgroup.…”

Section: Prognosismentioning

confidence: 99%

Scleroderma: Nomenclature, etiology, pathogenesis, prognosis, and treatments: Facts and controversies

Fett¹

2013

Clinics in Dermatology

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Section: Prognosismentioning

confidence: 99%

Scleroderma: Nomenclature, etiology, pathogenesis, prognosis, and treatments: Facts and controversies

Fett¹

2013

Clinics in Dermatology

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“…Those results suggested that a more concentrated dose at the lesion location might be necessary for adequate TNF blockade. Nonetheless, Diab et al 5 reported a successful case of systemic infliximab therapy in a patient with generalized morphea and LS, and, to our knowlege, there are no data to suggest either route's superiority.…”

Section: Commentmentioning

confidence: 91%

Intralesional Adalimumab for the Treatment of Refractory Balanitis Xerotica Obliterans

Lowenstein¹,

Zeichner²

2013

JAMA Dermatol

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“…Conversely, two cases have described beneficial effects of infliximab in severe morphea cases [102, 103]. Moreover, elevation of TNF-α in circulation in active morphea endorses the role of this cytokine in the development of morphea [66, 68].…”

Section: Pathogenesismentioning

confidence: 99%

Morphea and Eosinophilic Fasciitis: An Update

et al. 2017

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Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud’s phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.

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Treatment of Recalcitrant Generalized Morphea With Infliximab

Cited by 46 publications

References 8 publications

Scleroderma: Nomenclature, etiology, pathogenesis, prognosis, and treatments: Facts and controversies

Scleroderma: Nomenclature, etiology, pathogenesis, prognosis, and treatments: Facts and controversies

Intralesional Adalimumab for the Treatment of Refractory Balanitis Xerotica Obliterans

Morphea and Eosinophilic Fasciitis: An Update

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