Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9069, USA.
J Am Acad Dermatol. 2011 Nov;65(5):925-41. doi: 10.1016/j.jaad.2010.09.006. Epub 2011 Jun 8.
Morphea (localized scleroderma) is a skin disorder with significant morbidity. No consistent recommendations exist for therapy, impeding patient care.
We sought to create an evidence-based therapeutic algorithm.
We reviewed English-language literature using search engines and hand searches for therapeutic interventions in morphea. Results were summarized.
Narrowband ultraviolet B is appropriate for progressive or widespread superficial dermal lesions; broadband ultraviolet A/ultraviolet A-1 is appropriate for widespread or progressive deeper dermal lesions. Systemic treatment with methotrexate, corticosteroids, or both is indicated for deep or function-impairing lesions and rapidly progressive or widespread (severe) disease. Topical treatment with calcipotriene or tacrolimus is supported for limited, superficial, inflammatory lesions. Use of oral calcipotriol, D-penicillamine, interferon gamma, and antimalarials is not supported.
Limitations are publication bias; lack of adequately powered, controlled trials; and no validated outcome measures.
Phototherapy, methotrexate/systemic corticosteroids, calcipotriene, and topical tacrolimus have the most evidence for efficacy in morphea. Treatment works best in inflammatory disease. Disease activity, severity, progression, and depth should play a role in therapeutic decision making.
硬斑病（局限性硬皮病）是一种具有显著发病率的皮肤疾病。目前尚无针对该疾病的治疗方法的一致性推荐意见，这给患者的治疗带来了困难。
我们旨在制定一种基于循证医学的治疗算法。
我们使用搜索引擎和手工检索的方法，检索了有关硬斑病治疗干预措施的英文文献，对检索结果进行了总结。
窄谱中波紫外线（NB-UVB）适用于进展性或广泛的浅表真皮病变；宽谱中波紫外线（BB-UV-A）/中波紫外线-A1（UVA-1）适用于广泛或进展性的深层真皮病变。对于深部或影响功能的病变以及快速进展或广泛（严重）的疾病，建议采用甲氨蝶呤、皮质类固醇或两者联合的全身治疗。局部治疗可选择卡泊三醇或他克莫司，用于治疗局限性、浅表性、炎症性病变。不推荐口服卡泊三醇、青霉胺、干扰素 γ 和抗疟药。
存在发表偏倚、缺乏足够大的、对照良好的临床试验以及缺乏经过验证的疗效评估方法。
光疗、甲氨蝶呤/全身皮质类固醇、卡泊三醇和他克莫司治疗硬斑病的疗效最确切。治疗效果在炎症性疾病中最佳。疾病活动度、严重程度、进展情况和病变深度应在治疗决策中发挥作用。
