ConditionSkin, hair & nails
Morphea (Localized Scleroderma)
Morphea, also called localized scleroderma, is an uncommon inflammatory skin condition that causes patches of skin to harden and thicken. Patches often start as purplish or reddish areas, then become firm, smooth and ivory-white in the center, and later may soften and leave brown discoloration. Unlike systemic sclerosis, morphea does not affect internal organs. Some types, especially linear morphea in children, can affect underlying muscle, joints and growth, so early treatment matters.
Also called: Localized scleroderma, circumscribed scleroderma, linear scleroderma, en coup de sabre (a facial type)
At a glance
- What it is
- Localized hardening and thickening of the skin from excess collagen.
- Types
- Plaque (circumscribed), generalized, linear (including en coup de sabre), pansclerotic, mixed.
- Who
- Adults (mostly women) and children; linear morphea is more common in children.
- Internal organs
- Not involved, unlike systemic sclerosis.
- Treatment
- Topical steroids or calcipotriene, phototherapy, and methotrexate for active linear or widespread disease.
When to get help
See a doctor within a day or two
- A linear patch on a child's face, scalp, arm or leg that is spreading, especially over a joint or with limb length difference
- Facial morphea with headaches, seizures, eye problems or dental changes
Book a routine appointment
- A new firm, shiny or discolored patch of skin that is expanding
- Patches limiting joint movement or causing pain
- Fingers turning white or blue in the cold, heartburn, difficulty swallowing or shortness of breath (features of systemic sclerosis, which need assessment)
Usually safe to manage at home
- A known, stable, inactive plaque that is soft and not changing
What morphea is
In morphea, an immune-driven process causes inflammation in the skin, followed by overproduction of collagen by fibroblasts. The skin becomes thick, firm and less elastic. The cause is unknown. Possible triggers include local trauma, radiation therapy, infections and genetic predisposition. It is not contagious and is not cancer.
Morphea vs systemic sclerosis
| Morphea | Systemic sclerosis | |
|---|---|---|
| Organs | Skin and sometimes underlying tissue | Skin plus lungs, heart, kidneys, gut |
| Raynaud's phenomenon | Uncommon | Very common |
| Fingers | Usually spared | Tight, thickened (sclerodactyly) |
| Progression to systemic | Very rare | N/A |
Both fall under the umbrella term scleroderma, but they are different diseases.
Types and symptoms
Plaque (circumscribed) morphea
The most common type in adults. Oval patches, often on the trunk, with:
- an early purplish or lilac border (showing activity)
- a firm, shiny, ivory or white center
- loss of hair and sweating in the patch
- later, softening and brown discoloration
Generalized morphea
Four or more large plaques involving at least two body areas, sometimes merging over much of the trunk.
Linear morphea
Bands of hardened skin along a limb or the face, mostly in children. It can involve fat, muscle and bone, causing:
- limb length differences and joint contractures
- muscle wasting
En coup de sabre is a linear band on the forehead and scalp, resembling a sword cut. It may be associated with brain, eye or dental changes. Parry-Romberg syndrome (progressive hemifacial atrophy) is a related condition.
Pansclerotic morphea
A rare, severe form affecting the full thickness of the skin and deeper tissue over large areas.
Other symptoms
- itching or mild discomfort
- joint pain or stiffness with deeper involvement
- fatigue in some people
Diagnosis
- examination of patches and their distribution
- skin biopsy if the diagnosis is uncertain, or to distinguish from lichen sclerosus, which can overlap
- blood tests are usually normal; some people have positive ANA
- MRI or ultrasound for linear or deep morphea to assess underlying tissue
- eye exam and brain MRI for facial linear morphea in children
- photographs and measurements to track activity
Treatment
Treatment works best during the active inflammatory phase.
Limited plaque morphea
- topical corticosteroids
- topical calcipotriene (a vitamin D analog), sometimes combined with steroids
- topical tacrolimus
- phototherapy (UVA1 or narrowband UVB)
Linear, generalized or deep morphea
- methotrexate, often with an initial course of systemic corticosteroids, for 1 to 2 years or more; this is the standard approach in children with linear morphea
- mycophenolate if methotrexate fails or is not tolerated
- newer immune treatments in specialist centers for resistant disease
Supportive care
- physical therapy to maintain joint movement and prevent contractures
- moisturizers for dry, tight skin
- reconstructive surgery or fat grafting for facial atrophy once disease is inactive
- psychological support for appearance-related concerns
Outlook
Plaque morphea usually stays active for 3 to 5 years, then softens, though discoloration often remains. Relapses can occur. Linear morphea tends to last longer and may cause lasting functional or growth effects if not treated early. Morphea does not shorten life expectancy.
Frequently asked questions
What is morphea?
Morphea is a skin condition in which patches of skin become thick, hard and discolored because of excess collagen. It is a form of localized scleroderma, but unlike systemic sclerosis, it does not affect internal organs.
Is morphea the same as scleroderma?
Morphea is called localized scleroderma, but it is different from systemic sclerosis, which affects internal organs like the lungs, kidneys and gut. Morphea affects the skin and sometimes the tissue underneath, and very rarely progresses to systemic disease.
What does morphea look like?
Typical patches are oval and firm, with a shiny, ivory or white center and a purple or reddish border when active. Later they can soften and leave brown discoloration. Linear morphea appears as a band along a limb or the forehead.
How is morphea treated?
Mild plaques are treated with topical steroids, calcipotriene or tacrolimus and phototherapy. Linear, widespread or deep morphea usually needs methotrexate, sometimes with steroids. Physical therapy helps maintain joint movement.
Does morphea go away?
Plaque morphea often becomes inactive after 3 to 5 years and softens, though color changes may remain. Linear morphea can be more persistent. Treatment during the active phase helps limit damage.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Morphea - Diagnosis and Treatment
- National Scleroderma Foundation: Localized Scleroderma
- DermNet: Morphoea
- MedlinePlus: Localized scleroderma
- Childhood Arthritis and Rheumatology Research Alliance (CARRA): Juvenile Localized Scleroderma Treatment Plans