Evaluation of the efficacy and safety of topical imiquimod 5% for plaque-type morphea: a multicenter, prospective, vehicle-controlled trial.

J Cutan Med Surg

Divisions of Dermatology and Cutaneous Sciences and Pediatric Dermatology and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, ABDivision of Anatomical Pathology, University of British Columbia, Victoria, BC.

Published: September 2015

Background: There is currently a lack of evidence-based therapies that are safe and effective for plaque-type morphea. We aimed to evaluate the therapeutic potential and safety profile of imiquimod 5% cream in plaque-type morphea.

Methods: We enrolled 25 adult patients from two Canadian centers with histologically confirmed plaque-type morphea. Imiquimod 5% was applied to a representative plaque, and vehicle was applied to a control plaque for 9 months. Treatment efficacy was assessed with the Dyspigmentation, Induration, Erythema, and Telangiectasias (DIET) score, histology, and ultrasound evaluation.

Results And Conclusions: Twenty-two patients completed the entire length of the study. Imiquimod 5% was superior to vehicle in reducing DIET scores at 3, 6, 9, and 12 months (p < .05). Induration demonstrated the greatest response. Histologic evaluation showed significant improvement or resolution of disease. However, no ultrasonographic differences were found in dermal and hypodermal thicknesses between the treatment and vehicle groups (p > .05). Adverse effects were minimal and well tolerated.

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http://dx.doi.org/10.2310/7750.2014.14072DOI Listing

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Article Synopsis
  • Morphea is a rare autoimmune disease affecting the skin and subcutaneous tissues, with this study analyzing 78 patients to explore its demographic, clinical, and histological characteristics between 2016 and 2022.
  • The plaque type was the most common clinical presentation (87.5%), with significant histopathological findings such as complete homogenization of dermal collagen (100%) and significant loss of skin appendages (98.7%).
  • Key observations included varying histopathological features and a notable association of certain signs in lower extremity lesions, suggesting morphea’s complex diagnosis may require careful clinical correlation.
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Methods: A cross-sectional study has been carried out among adult morphea patients.

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We report a 10-year-old boy with localized scleroderma of the linear and plaque type, who showed proteinuria and hematuria. In this patient, skin, articular, and renal manifestations appeared successively and then began to resolve in the same order. A renal biopsy specimen demonstrated mild mesangial cell proliferation, exudate of immunoglobulin in the glomerular capillary, and large electron-dense deposits in the afferent arteriole.

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The effects of many dermatologic syndromes are not exclusive to the skin. Disorders commonly involve a complex interplay between multiple organ systems, thus not relying solely on the dermatologist for proper work up, diagnosis, and treatment. Morphea is one such rare disease which involves progressive loss or atrophy of subcutaneous tissue, muscle, and bone with a relatively mysterious etiology.

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