Delays in diagnosis, variations in treatment for morphea

(HealthDay)—Patients with localized scleroderma (morphea) often experience delay in diagnosis and variability in treatment that is based more on the specialty of the provider than disease characteristics, according to a study published in the November issue of the Journal of the American Academy of Dermatology.

Weilan Johnson, M.D., from the Texas Health Presbyterian Hospital Dallas, and Heidi Jacobe, M.D., from the University of Texas Southwestern Medical Center, assessed the duration between morphea onset and diagnosis in a cohort of 224 patients. The specialty of the provider, initial evaluation, and therapy were also examined.

The researchers found that 63 percent of patients received a diagnosis more than six months after morphea onset. Most patients (83.5 percent) were diagnosed and treated by dermatologists, with the more severe forms of morphea (linear and generalized) diagnosed and treated by rheumatologists. Topical corticosteroids were the most commonly prescribed therapy (63 percent). Dermatologists mainly prescribed topical treatments or phototherapy, even for those with linear and generalized morphea, while rheumatologists mainly prescribed systemic immunosuppressives and physical therapy.

"In summary, we identified several factors that impact the care of patients with morphea," the authors write. "These include delay in diagnosis and treatment, large variation in evaluation and therapy based on the specialty of the provider, and widespread use of evaluations and therapy with little evidence for their efficacy."