Generalized morphea, a rare and severe variant of localized scleroderma, is marked by extensive skin involvement with multiple hardened plaques and hyperpigmentation. The pathogenesis of generalized morphea is still unclear, and there is no established therapy. The aim of this article is to present a novel treatment approach for generalized morphea while also conducting a systematic review of previously published cases to summarize and analyze the clinical features and current effective treatment strategies for this condition. We herein describe the case of a 61-year-old male patient with generalized morphea successfully treated with tripterygium glycosides (TG) and hydroxychloroquine (HCQ). The systematic review analyzed a total of 77 patients with generalized morphea, comprising 76 previously reported cases (57 adults and 19 children) and one adult patient from our article. Compared with the adult group, the pediatric group demonstrated significantly higher rates of abnormal antinuclear antibodies (78.9%, p=0.002) and a greater proportion of severe cases (89.5%, p=0.001). Furthermore, systemic glucocorticoid is currently the most frequently used and effective treatment (p=0.016). In the treatment of generalized morphea, the combination of HCQ and TG may represent a potentially useful therapeutic option worthy of further investigation.
Sun et al. (2026) studied this question.