This blog post summarises the key insights from the latest Virtual Education Session (VES) presented by Associate Professor Amanda Saracino, a fellow of the Australian College of Dermatologists and an associate professor with the University of London.

Associate Professor Amanda Saracino, a recognised consultant dermatologist in many countries, is widely published, and is invited as a peer reviewer for many Australian, US, UK and European dermatology and rheumatology journals.

For more free resources, access our in-depth and targeted information brochures by clicking here, or click here to go directly to our morphoea-specific brochure.

Understanding Scleroderma and Morphoea: Key Points

  • Scleroderma refers to autoimmune conditions that cause skin and connective tissue hardening.
  • Morphoea (localised scleroderma) affects only the skin – it does not involve internal organs or progress to a systemic level.
  • Morphoae appears as firm, discoloured patches or streaks on the skin that may thicken, harden or restrict movement if deeper tissues are affected.
  • Causes are autoimmune, possibly triggered by genetics, infection, or environmental factors.
  • Treatment depends on severity – topical creams, phototherapy, or systemic medications like methotrexate are common options.
  • Early diagnosis and monitoring help prevent scarring and maintain mobility.
  • Morphoea can coexist with other autoimmune conditions such as lichen sclerosus, so multidisciplinary care is important.
  • While chronic, most people with morphoea experience stabilisation and softening of lesions with treatment.

Scleroderma and Morphoea

Scleroderma and morphoea are complex autoimmune conditions that affect the body’s connective tissue, resulting in skin thickening and, in some cases, deeper tissue involvement. While both share the feature of excessive collagen production, they differ in their scope, presentation and long-term implications. Understanding these distinctions is essential for accurate diagnosis, effective management, and supporting those affected by these rare conditions.

What Is Scleroderma?

Scleroderma, meaning “hard skin”, is an umbrella term for autoimmune disorders that cause fibrosis (hardening) of the skin and, at times, internal organs. The two primary forms are systemic sclerosis and localised scleroderma (morphoea).

Systemic sclerosis affects not only the skin but also internal organs such as the lungs, heart, gastrointestinal tract and kidneys. In contrast, morphoea involves localised areas of skin thickening without internal organ involvement.

Both forms result from an overactive immune response that triggers fibroblasts to produce excess collagen. The cause remains unclear, though genetic, immune, and environmental factors all appear to play a role.

What Is Morphoea?

Morphoea is a localised form of scleroderma that primarily affects the skin and sometimes the underlying fat, fascia or muscle. It is not contagious, not cancerous, and does not evolve into systemic sclerosis.

Morphoea presents in several subtypes, including:

  • Plaque morphoea, the most common form, appearing as one or more oval, firm, discoloured patches on the skin.
  • Linear morphoea, which often runs along a limb or the face and can affect deeper tissues.
  • Generalised morphoea, involving multiple larger plaques across the body.

These lesions typically begin as reddish or purplish patches that gradually harden and become shiny or ivory-coloured. Over time, they may soften or leave behind areas of pigmentation or scarring.

Causes and Risk Factors

While the exact cause is unknown, morphoea is thought to arise from an autoimmune process in which the body mistakenly attacks its own tissues. Some people report preceding triggers such as radiation, infection, trauma or certain medications. Hormonal factors may also play a role, as morphoea is more common in women.

Diagnosis and Clinical Assessment

Diagnosis is based on clinical examination, supported by skin biopsy when necessary. Blood tests may show autoantibodies, though these are not specific to morphoea. Because the condition can mimic other skin disorders, dermatologists and rheumatologists often collaborate in assessment and management.

Imaging such as MRI or ultrasound may be used to determine the depth of involvement, particularly in cases where joint mobility or deeper tissue structures are affected.

Treatment and Management

Treatment depends on the type, location and severity of morphoea. While some mild cases may resolve over time, active morphoea should be treated early to prevent scarring or functional impairment.

Common management approaches include:

  • Topical therapies such as corticosteroids, calcipotriol, or tacrolimus for mild, localised patches.
  • Phototherapy (narrowband UVB or UVA1) to soften thickened skin and reduce inflammation.
  • Systemic medications like methotrexate or corticosteroids for more extensive or deep involvement.

Physiotherapy and occupational therapy can also play a vital role, particularly for patients with linear morphoea affecting limb movement or facial involvement.

Oral and Dental Involvement

While morphoea generally affects the skin, some forms – particularly en coup de sabre on the face or scalp – can impact deeper tissues and occasionally the mouth area. In these cases, dental professionals should be part of the care team to monitor gum health, oral aperture changes and jaw mobility.

Collaboration between dermatologists, rheumatologists, dentists and speech therapists can help ensure comprehensive care for those with facial or oral involvement.

Related Autoimmune Conditions

Morphoea may coexist with other autoimmune or inflammatory skin disorders, such as lichen sclerosus. Both conditions can involve localised skin hardening, but they differ in cause, location and prognosis.

Lichen sclerosus commonly affects genital or perianal skin, causing itching and white, thin patches. It is managed differently, typically with potent topical corticosteroids. Recognising and differentiating between these conditions is important for appropriate treatment and patient reassurance.

Monitoring and Follow-Up

Regular follow-up is important to assess morphoea activity and treatment response. Patients with morphoea should have:

  • Periodic skin assessments to detect new or progressing lesions.
  • Functional monitoring if joints or mobility are affected.
  • Photographs or skin mapping to document changes over time.

Because morphoea can recur even after periods of inactivity, ongoing observation is recommended.

Common Questions About Morphoea and Scleroderma

Is morphoea the same as scleroderma?
 Morphoea is a localised form of scleroderma that affects only the skin. Systemic sclerosis, on the other hand, can involve internal organs.

Can morphoea turn into systemic sclerosis?
 No. Morphoea remains localised and does not progress to systemic sclerosis. However, patients should be reviewed regularly to monitor any new symptoms.

Does morphoea cause pain or itchiness?
 Some lesions may feel tight, itchy or tender, especially during active phases. Once the inflammation settles, discomfort usually subsides.

Can children get morphoea?
 Yes. Morphoea can occur in both adults and children, with linear morphoea being more common in younger individuals. Early intervention is important to prevent growth disturbances or contractures.

What is the outlook for people with morphoea?
 With appropriate treatment and monitoring, most people experience stabilisation and softening of lesions. Some discolouration or texture changes may persist, but long-term complications are uncommon.

Final Take Away

Scleroderma and morphoea represent a spectrum of autoimmune conditions that vary in severity and scope. While morphoea is confined to the skin, its potential to affect quality of life should not be underestimated. Prompt recognition, appropriate treatment, and multidisciplinary care can make a significant difference in long-term outcomes.

Ongoing research continues to shed light on the mechanisms behind these rare conditions, offering hope for improved therapies and better understanding in the years ahead.

For those living with Scleroderma, staying updated and informed can make a world of difference. Connecting with others can also be hugely beneficial. Find out more about support in your area by clicking here. 

If you’d like to gain firsthand knowledge, our National Education Sessions and Virtual Education Sessions are available to you at no charge. Our Virtual Education Sessions are held every month through Google Meet. You can sign up for these free Virtual Education Sessions by clicking here.

These sessions provide an opportunity to engage with medical professionals and seasoned legal experts who will address common inquiries about Scleroderma and related topics.