Localised Morphea Treated Empirically with Ceftriaxone

Abstract

Localised morphea is an autoimmune sclerosing disorder of unknown aetiology. Various triggering factors are known to be associated with the disease including infections, vaccination, autoimmune disorders, and trauma. Amongst the infections, the common causative organisms associated with morphea are Borrelia burgdorferi, varicella, and Epstein-Barr virus (EBV). EpsteinBarred morphea presents as an initial inflammatory stage and a later inactive stage. It is characterised by sclerosis of skin with hyper or depigmentation. The antibiotics effective against borrelia infection are benzyl penicillin, doxycycline, and ceftriaxone. These antibiotics are tried in the treatment of localised morphea. Ceftriaxone is one of the best antibiotics preferred to treat borrelia infection at all stages. Apart from its antibiotic properties, it also has an anti-inflammatory and collagen remodelling properties. All five cases of localised morphea reported here were biopsy proven, Antinuclear Antibody (ANA) and Rheumatoid Arthritis (RA) factor negative. All the cases were treated with weekly single intramuscular dose of ceftriaxone 250 mg. After eight weeks there was remarkable improvement in the induration and pigmentation of the lesions.