Linear morphea: a case series with long-term follow-up of young, methotrexate-treated patients

Abstract

BACKGROUND: Linear morphea can lead to significant morbidity and functional disability in young patients. Methotrexate (MTX), with or without a short initiation with prednisone therapy, has been used and documented as a well-tolerated, effective treatment regimen. PURPOSE: To evaluate the long-term efficacy of MTX therapy in patients with linear morphea. METHODS: A retrospective chart review was performed for pediatric and young adult patients with linear morphea and evaluated in the Dermatology Clinic at Wake Forest University School of Medicine treated with MTX. RESULTS: Seventeen patients met inclusion criteria and were followed for an average of 6.6 years. All patients improved with MTX therapy, with an average of 2.1 months to disease inactivity, and 19.6 months to discontinuation of MTX. Seven patients (41%) required a second course of MTX, following an average remission of 21 months. One patient (6%) required a third course, following 6.9 years of remission. LIMITATIONS: Retrospective chart review with a small patient sample size, and several patients were lost to follow-up. CONCLUSIONS: MTX is effective for achieving disease inactivity in pediatric and young adult patients with linear morphea. MTX is also effective in achieving disease remission off of therapy. However, many patients eventually required more than one course of MTX.