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Localized scleroderma is a rare disorder with not well recognized aetiology. Though considered to be a benign disorder it may result in a severe cosmetic disfigurement or even functional disability. There is no proven effective therapy for localized scleroderma so far making management of such cases challenging. Lack of evidence based treatment and standardization of evaluation methods may be reason for it. The Study was conducted to evaluate the role of corticosteroid and methotrexate therapy in our population with severe localized scleroderma (morphoea). Material and Methods: All patients attending with OPD in Department of Dermatology SKIMS-MCH from Jan, 2014, to Jan, 2019, with clinical features suggestive of active, moderate to severe morphoea were enrolled in the study. A detailed clinical history was followed by a thorough clinical examination and calculation of LoSSI score. Patients were started on i/v methyl-prednisolone 30mg/kg monthly pulses as 3 consecutive doses for 3 months (maximum 1gm) and intramuscular MTX at 0.2 to 0.4 mg/kg/week (maximum 25 mg/week) for 12 months. Results: A total of 21 patients were included in the study. Male: Female ratio was 1:3.2. Mean age was 21.19years. Linear morphoea was most common type (13 cases) followed by plaque morphoea (6 cases). There was a significant decrease in mean LoSSI score (from 15.19 to 6.62) at 4 months after completion of steroid methotrexate phase (value of t is -8.621425, value of p is < .00001). Mean LoSSI score after completion of 12 months of treatment was 0.94 (value of t is -9.644953, value of p is < .00001). The treatment was well tolerated. Conclusion: The study suggests that systemic corticosteroids and methotrexate in combination is effective and well tolerated treatment for both adults and children with localized moderate to severe scleroderma.

international journal of contemporary medical research

Evaluation of Corticosteroid and Methotrexate Therapy in the Treatment of Moderate to Severe Localized Scleroderma (Morphoea) – A 5 Year Study in a Teaching Hospital of North India