Pulsed high-dose steroids effective in severe localised scleroderma

A recent open-label pilot study reports that pulsed high-dose corticosteroids combined with low-dose oral methotrexate therapy is effective in treating localised scleroderma (LS).Introducing their study, Dr Alexander Kreuter (Ruhr-University, Bochum, Germany) comments that "The etiology of LS remains unknown, but autoimmune, genetic, infectious, and environmental factors have been implicated." To date, no proven effective therapy for LS has been implemented.... Both low-dose methotrexate and oral corticosteroid treatment are reportedly effective in severe forms of LS in adults and children."To evaluate the efficacy of pulsed high-dose corticosteroids combined with orally administered low-dose methotrexate therapy in patients with severe LS the group enrolled 15 patients with histologically confirmed severe LS. These subjects received oral methotrexate (15mg/week), combined with pulsed intravenous methylprednisolone (1,000mg for three days monthly), for at least six months. Overall, 14 patients completed the study and reported significant improvements in all signs of active disease (inflammation) and softening of formerly affected sclerotic skin. This was demonstrated by a decrease of the mean clinical score from 10.9 at the beginning to 5.5 at the end of therapy (pThe authors' comment, "pulsed high-dose corticosteroids combined with orally administered low-dose methotrexate therapy is beneficial and safe in the treatment of patients with LS." Dr Kreuter's group call for further investigation and add that, "This treatment regimen should especially be considered for severe forms of LS in which conventional treatments have failed."Reference...