Document Detail

Evaluation of methotrexate and corticosteroids for the treatment of localized scleroderma (morphoea) in children.
MedLine Citation:
PMID:  17034534     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Localized scleroderma (LS) or morphoea is often considered to be a benign self-limiting condition confined to the skin and subcutaneous tissue. However, the course of the disease is unpredictable and severe functional and cosmetic disability may result. Drug treatment with systemic corticosteroids in combination with methotrexate has been reported to be beneficial in LS, but data in children is limited. OBJECTIVES: To evaluate the efficacy and tolerability of systemic corticosteroids in combination with methotrexate in children with LS. METHODS: Treatment and outcome of 34 patients with LS were retrospectively analysed. Pulsed intravenous methylprednisolone was given, followed by oral prednisolone on a reducing regimen and maintenance treatment with methotrexate. We assessed treatment outcome clinically and by thermography and monitored adverse events. RESULTS: From the onset of treatment, the disease stopped progressing in 94% of the patients. All patients demonstrated significant clinical improvement within a mean time of 5.7 +/- 3.9 months. Mean duration of follow-up over the treatment period and beyond was 2.9 +/- 2.0 years. In 16 (47%) patients therapy was discontinued when the disease was considered to be inactive clinically; however, seven (44%) of the 16 developed a relapse, necessitating repeat treatment. At last follow-up (range 0.2-7.0 years), 24 (71%) of the 34 patients had completely inactive disease. Observed adverse events were moderate and transient and no patient had to stop therapy. CONCLUSIONS: These data suggest that systemic corticosteroids and methotrexate in combination are beneficial and well tolerated in the treatment of children with LS. Because of the risk of relapse after discontinuing therapy, long-term monitoring is mandatory.
L Weibel; M C Sampaio; M T Visentin; K J Howell; P Woo; J I Harper
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of dermatology     Volume:  155     ISSN:  0007-0963     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-12     Completed Date:  2007-03-15     Revised Date:  2007-09-06    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1013-20     Citation Subset:  IM    
Paediatric Rheumatology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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MeSH Terms
Child, Preschool
Dermatologic Agents / therapeutic use*
Disease Progression
Drug Evaluation
Drug Therapy, Combination
Follow-Up Studies
Glucocorticoids / adverse effects,  therapeutic use*
Methotrexate / adverse effects,  therapeutic use*
Prednisolone / adverse effects,  therapeutic use
Retrospective Studies
Scleroderma, Localized / drug therapy*
Treatment Outcome
Reg. No./Substance:
0/Dermatologic Agents; 0/Glucocorticoids; 50-24-8/Prednisolone; 59-05-2/Methotrexate
Comment In:
Br J Dermatol. 2007 Jun;156(6):1363-5   [PMID:  17441961 ]

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