Clinical Profile of Methotrexate-resistant Juvenile Localised Scleroderma
Juliette Hardy, Franck Boralevi, Stéphanie Mallet, Natalia Cabrera, Alexandre Belot, Alice Phan, Sébastien Barbarot, Audrey Duriez-Lasek, Christine Chiaverini, Thomas Hubiche, Emmanuel Mahé, Edouard Bégon, Emmanuelle Bourrat, Olivia Boccara, Hélène Aubert, Martine Grall Lerosey, Catherine Droitcourt, Maryam Piram, Juliette Mazereeuw-Hautier, and Research Group of the French Society of Paediatric Dermatology (SDFP in French)
Methotrexate has demonstrated its efficiency for the treatment of juvenile localized scleroderma but some patients may be resistant. The aim of our study was to define the profile of such patients. We performed an observational retrospective multicenter study between 2007 and 2016 and included all children seen in the French Paediatric Dermatology and Rheumatology departments with active localized scleroderma treated by methotrexate for a minimum of 4 months. Methotrexate efficacy was assessed clinically and/or by imaging between the fourth to twelfth months of treatment. A total of 57 patients were included. Methotrexate dosage ranged from 7 to 15 mg/m2/week. Only 4 patients were resistant. No common features could be identified between these 4 patients. Children with localized scleroderma are rarely resistant to methotrexate and we did not identify a clinical profile for those resistant patients.
Morphea is a rare skin condition due, in part, to an unusual reaction of the immune system. Disease generally affects the outermost layers of the skin which becomes hard and thickened. In severe cases underlying tissue and bones can be affected resulting in functional disabilities. Methotrexate in association with systemic corticosteroids are the most frequent drugs prescribed for severe form of the disease. However some patient will not respond to these treatments. The aim of our study was to better define the clinical profile of these resistant patients in order to help clinicians in their therapeutic choice.