Attitudes and Trends in the Treatment of Morphea: A National Study
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INTRODUCTION: Morphea, or localized scleroderma, is an inflammatory disorder of both adults and children that can lead to severe cosmetic and functional impairment due to excess collagen deposition in the dermis and subcutaneous tissues. The attitudes of the main specialists caring for these patients, dermatologists and rheumatologists, have not been directly evaluated in regards to evaluation and treatment. Given the multidisciplinary management of this disease and the lack of a national perspective on physicians' current treatment regimens, there is no uniform standard of care for morphea, and the indications for aggressive treatment are not widely accepted among providers. We report here the results of a national cross-sectional survey of both dermatologists and rheumatologists, showing current practice patterns of evaluation and treatment of morphea in the United States. METHODS: A web-based cross-sectional survey was administered to physicians who were randomly selected from the current American Academy of Dermatology, Society of Pediatric Dermatology, and the American College of Rheumatology Membership Directories. RESULTS: Physician approach to evaluation and treatment of morphea is driven by the specialty training of the physician rather than the disease characteristics. For evaluation of morphea, all specialties de-emphasized subtyping morphea, instead strongly relying on the history and physical exam, a modality based on physician training. Over all morphea subtypes, dermatologists tended to utilize external treatments (topical steroids, phototherapy), while rheumatologists preferred systemic treatments (methotrexate, antimalarials/antibiotics, systemic steroids). Both specialties are willing to refer patients to their colleagues in other specialties when evaluation or treatments extend beyond their own training. For some morphea subtypes, each specialty did not have a clear consensus on first and second-line treatment. DISCUSSION: This is the first study to concurrently assess the evaluation and treatment practices of main stakeholders in morphea care. With the lack of standardized guidelines, dermatologists and rheumatologists rely heavily on specialty training for assessing and treating morphea patients. Even within a specialty, there are no clear agreements on treatment choices for individual morphea subtypes. This study 1) provides support for the necessity to develop evidence-based practice guidelines; 2) emphasizes the need for interdisciplinary collaboration that is already in place among these stakeholders; and 3) shows a national perspective on morphea care that can be used as a platform to launch consensus statements on morphea treatment.