Morphea, also referred to as localized scleroderma, is a rare skin condition characterized by thickening of the dermis or subcutaneous tissue or both. The inflammation is caused by increased collagen secretion due to the overproduction of collagen cells.
Morphea
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Morphea can be classified into various types based on the area of affectation. Patients can come down with itching, pain, and neurological deficits.
Morphea is rare and happens more often in females. The cause is not known, however, scientists suggest that genetics play a vital role.
Treatment of morphea includes steroids, tacrolimus, methotrexate, mycophenolate mofetil, phototherapy, and in some cases autologous fat transfer. Autologous fat transfer is the transfer of fat cells from one part of the body to another.
A new method of fat transplant
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Scientists have discovered a new way in which Morphea can be treated surgically. Juzi Liu et al. set out to determine if serial grafting with fresh fat and cryopreserved stromal vascular fraction (SVF) gel would yield better outcomes than regular autologous fat grafting.
They conducted a non-randomized controlled trial which involved the recruitment of 44 patients who have been diagnosed with Morphea. A total of 21 participants received fresh fat and cryopreserved SVF gel while the remaining 20 participants, the control group, received autologous fat.
They assessed the level of treatment response using the modified Localized Scleroderma Skin Severity Index (mLoSSI) and Localized Scleroderma Skin Damage Index (LoSDI) scores. After 12 months, MmLoSSI values showed a decline of 1.6 in the first group and 0.9 in the second group while LoSDI values showed a decline of 4.3 in the first group and 2.1 in the second group.
Histology showed reduced degeneration and skin damage in group 1 compared to group 2. Also, they recorded increased skin regeneration and lowered skin sclerosis. Tumor necrosis factor (TNF) α signaling via NFκB was noticed on transcriptome analysis leading the researchers to suggest that TNF α signaling might have suppressed immune reaction to the implanted material. Some genes such as CTGF, PAI-1, and EDN1 said to be associated with the disease process were also found to be suppressed.
Clinical significance
This more effective method of fat transplant is a better option for patients with severe Morphea. The results show that it yields better therapeutic effects through skin regeneration and reduced sclerosis, which gives patients a better quality of life.
Are patients not at risk of immune reactions?
Some concerns have been raised regarding the fresh fat and SVF gel used for the transplant. In as much as TNF α was identified to have immunosuppressive properties, in the long term, the patient’s immune system might tilt towards transplant rejection, further worsening the clinical state of the patient.
Conclusion
Morphea is a lifelong rare disease that reduces the quality of life of people who are diagnosed with it. Fresh fat and SVF gel transplants have proven to be beneficial. More research is needed to strengthen this evidence and discover more ways to treat Morphea.
References
Liu, J., Wang, J., Zhang, Q., Lu, F., & Cai, J. (2024, February 7). Clinical, Histologic, and Transcriptomic Evaluation of Sequential Fat Grafting for Morphea. JAMA Dermatology. https://doi.org/10.1001/jamadermatol.2023.5908
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