Methotrexate Superior to Phototherapy in Childhood Localized Scleroderma, Study Finds

A methotrexate (MTX) treatment protocol that includes the administration of glucocorticoids is superior to phototherapy in treating childhood localized scleroderma, a study found. Nonetheless, researchers suggest MTX should be used preferentially in more severe cases of the disease.

The study, “Comparing ultraviolet light A photo(chemo)therapy with Methotrexate protocol in childhood localized scleroderma: Evidence from systematic review and meta-analysis approach,” was published in the journal Seminars in Arthritis and Rheumatism.

Localized scleroderma involves fibrosis, or scarring, of the skin and underlying tissues, and approximately 50% of the cases begin in childhood. It can be a debilitating disease, causing deformity and impaired function in growing children.

There is no established optimal treatment for localized scleroderma.

In recent years, “methotrexate (MTX) with or without glucocorticoids, has been widely adopted by pediatric rheumatologists as first line treatment,” the researchers wrote.

However, there is still no international consensus among clinicians about the best treatment approach for the disease. While dermatologists commonly use topical agents and ultraviolet light A (UVA) phototherapy, rheumatologists prefer to use systemic immunosuppressive agents.

Researchers conducted a review of existing published studies regarding the effectiveness of MTX compared to phototherapy in children with localized scleroderma.

The results from 19 studies were analyzed on childhood-onset localized scleroderma, conducted from January 1996 to May 2017.

From this group, a total of 193 children (mean age at treatment was 8.49) received MTX; 182 (94%) of these children also received glucocorticoid treatment. Glucocorticoids are used as a hormone therapy to reduce inflammation in a variety of disorders, including scleroderma.

A total of 48 children (mean age at treatment was 10.75) received UVA phototherapy (exposure of affected areas to ultraviolet A light).

Results showed that both treatment strategies have a favorable effect on active lesions in children with localized scleroderma. However, MTX was superior, with 93% of the children responding to the treatment, compared to 71% in the group treated with phototherapy.

Overall, phototherapy was effective in 31 out of the 48 patients analyzed who received this treatment (64%).

One study in particular showed that in the MTX-treated group, remission of symptoms was observed in 67.4% of patients at the one-year follow-up.

According to the team, the results of the study “could be helpful for clinicians making therapeutic decisions in childhood-onset localized scleroderma.”

Researchers noted, however, that children treated with MTX were at a higher risk of complications than those who received phototherapy. Therefore, they suggested that MTX could be an appropriate treatment for more severe cases of the disease, whereas phototherapy could be used in less severe cases.

“Our study supports the combination of MTX and [glucocorticoids] in patients with a high risk of complication. Phototherapy with UVA could represent a therapeutic option in patients with limited scleroderma, where lesions do not cross joints and they do not lead to potential cosmetic changes,” they concluded.

Additional studies are still needed to determine the optimal treatment strategy in childhood-onset localized scleroderma, researchers added.