Clinical characteristics and histopathologic changes of morphea: A single-center, retrospective study of 137 patients.

Abstract

The clinicopathologic correlations and prognostic risk factors for refractory disease in morphea (localized scleroderma) are poorly described. To investigate the association between clinical characteristics and histopathologic features of morphea and identify risk factors for refractory disease. We retrospectively reviewed the clinical and histopathologic features, treatment regimens, and clinical responses for 137 patients with biopsy-proven morphea from January 2008 to May 2019. Multivariate analysis was conducted to identify factors associated with poor treatment response. We detected associations between the pattern and degree of sclerosis and the anatomic site of the lesion, as well as between severe inflammation and concomitant autoimmune disease. Additionally, both bottom-heavy sclerosis and increased inflammation were associated with functional limitations/clinical symptoms. Based on our multivariate analysis, we found that increased risk of poor treatment response was correlated with tissue eosinophils and basal pigmentation. This was a single-center retrospective study. Skin biopsy samples could show specific features of morphea, including eosinophil infiltration and basal pigmentation, which may indicate the need for aggressive treatment and frequent monitoring.