Scleroderma Clinical Trial
Official title:
Comparative Effectiveness Trial of Topical Calcipotriene, Clobetasol, and Tacrolimus in the Treatment of Pediatric Plaque Morphea
This is a study designed to evaluate the comparative effectiveness of topical medications for the treatment of circumscribed morphea.
Morphea, also known as localized scleroderma, is a rare autoimmune fibrosing disorder that
affects children and adults. Morphea causes significant morbidity through atrophy and
fibrosis of the skin and underlying structures. Treatment can halt the progression of disease
but cannot reverse disease damage, leaving children with disfiguring scars and sometimes
functional impairment. Consequently, it is of extreme importance to intervene early in the
disease course with effective therapies to limit morbidity.
Circumscribed morphea is the second most common subtype in children, comprising approximately
1/3 of pediatric morphea cases. It is a disfiguring disease that can cause pain and pruritus.
There are no FDA-approved treatments and no consensus exists on the ideal therapy for
circumscribed morphea, either in adults or children. Most physicians use topical medications
for circumscribed morphea yet there is little evidence to support these therapies. Topical
immune modulators such as tacrolimus, imiquimod, and calcipotriene have been investigated in
small studies, though these trials were limited by very small sample sizes of 9-19 patients
and lack of a control in most. Surveys have demonstrated that topical steroids are the most
commonly prescribed medication, even though the only evidence to support their use comes from
case reports. With insufficient evidence regarding topical therapies, providers have no
guidance when making treatment decisions, practice patterns vary widely even amongst
pediatric dermatologists, and children continue with preventable scars.
The investigators specific aim is to identify effective topical therapy for circumscribed
morphea. The investigators will utilize a comparative cohort study design to evaluate the
comparative effectiveness of three topical medications: clobetasol ointment, calcipotriene
ointment, and tacrolimus 0.1% ointment. The investigators will enroll subjects at CHW and
other institutions to achieve the study enrollment necessary to power this study.
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