vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v19i3.2119vsp-2397Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCEЮвенильная локализованная склеродермия. Вопросы леченияJuvenile Localized Scleroderma. Questions of Treatmenthttps://orcid.org/0000-0001-7749-6663РауповР. К.RaupovRinat K.

194100, Санкт-Петербург, ул. Литовская, д. 2

Saint Petersburg

https://orcid.org/0000-0002-1180-8086КостикМ. М.KostikMikhail M.

Костик Михаил Михайлович, доктор медицинских наук, профессор кафедры госпитальной педиатрии

194100, Санкт-Петербург, ул. Литовская, д. 2

Saint Petersburg

kost-mikhail@yandex.ruСанкт-Петербургский государственный педиатрический медицинский университетРоссияSt. Petersburg State Pediatric Medical UniversityRussian Federation202007072020193228234Copyright © Раупов Р.К., Костик М.М., 20202020Раупов Р.К., Костик М.М.Raupov R.K., Kostik M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/2397

Ювенильная локализованная склеродермия (ЮЛС) это группа заболеваний детского возраста, основное проявление которых — поражение кожи и подкожных структур, как правило, без органного вовлечения. В развитии ЮЛС выделяют активную (воспалительную) и фибротическую фазы. Терапия ЮЛС в активную фазу, когда проявления со стороны кожи носят обратимый характер, намного эффективнее. Тактика лечения определяется площадью и глубиной очагов кожного поражения, появлением и распространением новых очагов, наличием внекожных признаков болезни. Основой терапии ЮЛС служат топические и системные иммуносупрессанты. Антибиотикотерапия не показана. Для оценки эффективности терапии рекомендовано использовать клинические шкалы (LoSCAT), ультразвуковое исследование, термо- и магнитно-резонансную томографию.

Juvenile localized scleroderma (JLS) is a group of childhood diseases with the main symptom — skin and subcutaneous structures lesions, without any organ involvement. There is active (inflammatory) and fibrotic phase in development of JLS. The JLS treatment during active phase (when skin lesions are reversible) is the most effective. The management is determined by the area and depth of skin lesions, appearance and spread of new lesions, presence of extracutaneous signs of the disease. Topical and systemic immunosuppressants are the basic therapy for JLS. The use of antibiotics is not suggested. Clinical scores (LoSCAT), ultrasound, thermography and magnetic resonance imaging are recommended to estimate the treatment efficacy.

ювенильная локализованная склеродермияморфеялинейная склеродермиятопические глюкокортикостероидытакролимусметотрексатмикофенолата мофетилгенно-инженерные биологические препаратыjuvenile localized sclerodermamorphealinear morpheatopical glucocorticosteroidstacrolimusmethotrexatmycophenolate mofetilgenetically engineered biologic drugsРабота поддержана грантом РФФИ № 18-515-57001.The article is supported by RFBR grant № 18-515-57001.ReferencesКубанова А. А., Кубанов А. А., Мелехина Л. Е., Богданова Е. В. Анализ состояния заболеваемости болезнями кожи и подкожной клетчатки в Российской Федерации за период 2003– 2016 гг. //Вестник дерматологии и венерологии. — 2017. — № 6. — С. 22–33. doi: 10.25208/0042-4609-2017-93-6-22-33.Kubanova AA, Kubanov AA, Melekhina LE, Bogdanova EV. The Assessment of the Incidence of Skin Disorders in Russian Federation for the period 2003–2016. Vestnik Dermatologii i Venerologii. 2017;6:22–33. (In Russ). doi: 10.25208/0042-4609-2017-93-6-22-33.Laxer RM, Zulian F. Localized scleroderma. Curr Opin Rheumatol. 2006;18(6):606–613. doi: 10.1097/01.bor.0000245727.40630.c3.Laxer RM, Zulian F. Localized scleroderma. Curr Opin Rheumatol. 2006;18(6):606–613. doi: 10.1097/01.bor.0000245727.40630.c3.Zulian F, Culpo R, Sperotto F, et al. (2019). Consensus-based recommendations for the management of juvenile localised scleroderma. Ann Rheum Dis. 2019;78(8):1019–1024. doi: 10.1136/annrheumdis-2018-214697.Zulian F, Culpo R, Sperotto F, et al. (2019). Consensus-based recommendations for the management of juvenile localised scleroderma. Ann Rheum Dis. 2019;78(8):1019–1024. doi: 10.1136/annrheumdis-2018-214697.Kienast A, Foeldvari I. High Prevalence of Extracutaneous Manifestations and Comorbidities in 108 Patients with Juvenile Localized Scleroderma. Ann Rheum Dis. 2015;74(Suppl 2):612. doi: 10.1136/annrheumdis-2015-eular.1675.Kienast A, Foeldvari I. High Prevalence of Extracutaneous Manifestations and Comorbidities in 108 Patients with Juvenile Localized Scleroderma. Ann Rheum Dis. 2015;74(Suppl 2):612. doi: 10.1136/annrheumdis-2015-eular.1675.Condie D, Grabell D, Jacobe H. Morphea in Adults and Children Cohort VI: A cross-sectional comparison of outcomes between adults with pediatric-onset and adult-onset morphea. Arthritis Rheumatol. 2014;66(12):3496–3504. doi: 10.1002/art.38853.Condie D, Grabell D, Jacobe H. Morphea in Adults and Children Cohort VI: A cross-sectional comparison of outcomes between adults with pediatric-onset and adult-onset morphea. Arthritis Rheumatol. 2014;66(12):3496–3504. doi: 10.1002/art.38853.Knobler R, Moinzadeh P, Hunzelmann N, et al. European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes. J Eur Acad Dermatol Venereol. 2017;31(9):1401–1424. doi: 10.1111/jdv.14458.Knobler R, Moinzadeh P, Hunzelmann N, et al. European Dermatology Forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes. J Eur Acad Dermatol Venereol. 2017;31(9):1401–1424. doi: 10.1111/jdv.14458.Torok KS, Li SC, Jacobe HM, et al. Immunopathogenesis of Pediatric Localized Scleroderma. Front Immunol. 2019;10:908. doi: 10.3389/fimmu.2019.00908.Torok KS, Li SC, Jacobe HM, et al. Immunopathogenesis of Pediatric Localized Scleroderma. Front Immunol. 2019;10:908. doi: 10.3389/fimmu.2019.00908.Constantin T, Foeldvari I, Pain CE, et al. Development of minimum standards of care for juvenile localized scleroderma. Eur J Pediatr. 2018;177(7):961–977. doi: 10.1007/s00431-018-3144-8.Constantin T, Foeldvari I, Pain CE, et al. Development of minimum standards of care for juvenile localized scleroderma. Eur J Pediatr. 2018;177(7):961–977. doi: 10.1007/s00431-018-3144-8.Li SC, Feldman BM, Higgins GC, et al. Treatment of pediatric localized scleroderma: results of a survey of North American pediatric rheumatologists. J Rheumatol. 2010:37:175–181. doi: 10.3899/jrheum.090708.Li SC, Feldman BM, Higgins GC, et al. Treatment of pediatric localized scleroderma: results of a survey of North American pediatric rheumatologists. J Rheumatol. 2010:37:175–181. doi: 10.3899/jrheum.090708.Prinz JC, Kutasi Z, Weisenseel P, et al. «Borrelia-associated early-onset mophea»: a particular type of scleroderma in childhood and adolescence with high titer antinuclear antibodies? Results of a cohort analysis and presentation of three cases. J Am Acad Dermatol. 2009;60(2):248–255. doi: 10.1016/j.jaad.2008.09.023.Prinz JC, Kutasi Z, Weisenseel P, et al. «Borrelia-associated early-onset mophea»: a particular type of scleroderma in childhood and adolescence with high titer antinuclear antibodies? Results of a cohort analysis and presentation of three cases. J Am Acad Dermatol. 2009;60(2):248–255. doi: 10.1016/j.jaad.2008.09.023.Локализованная склеродермия: клинические рекомендации /Российское общество дерматовенерологов и косметологов. — 2016.Localized scleroderma: clinical recommendations /Russian Society of Dermatovenerologists and Cosmetologists. 2016. (In Russ.)Weide B, Walz T, Garbe C. Is morphoea caused by Borrelia burgdorferi? A review. Br J Dermatol. 2000;142(4):636–644. doi: 10.1046/j.1365-2133.2000.03407.x.Weide B, Walz T, Garbe C. Is morphoea caused by Borrelia burgdorferi? A review. Br J Dermatol. 2000;142(4):636–644. doi: 10.1046/j.1365-2133.2000.03407.x.Fan W, Leonardi CL, Penneys NS. Absence of Borrelia burgdorferi in patients with localized scleroderma (morphea). J Am Acad Dermatol. 1995;33(4):682–684. doi: 10.1016/0190-9622(95)91311-4.Fan W, Leonardi CL, Penneys NS. Absence of Borrelia burgdorferi in patients with localized scleroderma (morphea). J Am Acad Dermatol. 1995;33(4):682–684. doi: 10.1016/0190-9622(95)91311-4.Kreuter A, Krieg T, Worm M, et al. German guidelines for the diagnosis and therapy of localized scleroderma. J Dtsch Dermatol Ges. 2016;14(2):199–216. doi: 10.1111/ddg.12724.Kreuter A, Krieg T, Worm M, et al. German guidelines for the diagnosis and therapy of localized scleroderma. J Dtsch Dermatol Ges. 2016;14(2):199–216. doi: 10.1111/ddg.12724.National Center for Biotechnology Information. PubChem Database. Calcipotriol, CID=5288783. Available online: https://pubchem.ncbi.nlm.nih.gov/compound/Calcipotriol. Accessed on April 25, 2020).National Center for Biotechnology Information. PubChem Database. Calcipotriol, CID=5288783. Available online: https://pubchem.ncbi.nlm.nih.gov/compound/Calcipotriol. Accessed on April 25, 2020).Cunningham BB, Landells ID, Langman C, et al. Topical calcipotriene for morphea/linear scleroderma. J Am Acad Dermatol. 1998;39(2 Pt 1):211–215. doi: 10.1016/s0190-9622(98)70077-5.Cunningham BB, Landells ID, Langman C, et al. Topical calcipotriene for morphea/linear scleroderma. J Am Acad Dermatol. 1998;39(2 Pt 1):211–215. doi: 10.1016/s0190-9622(98)70077-5.Kreuter A, Gambichler T, Avermaete A, et al. Combined treatment with calcipotriol ointment and lowdose ultraviolet A1 phototherapy in childhood morphea. Pediatr Dermatol. 2001;18(3):241–245. doi: 10.1046/j.1525-1470.2001.018003241.x.Kreuter A, Gambichler T, Avermaete A, et al. Combined treatment with calcipotriol ointment and lowdose ultraviolet A1 phototherapy in childhood morphea. Pediatr Dermatol. 2001;18(3):241–245. doi: 10.1046/j.1525-1470.2001.018003241.x.Zwischenberger BA, Jacobe HT. A systematic review of morphea treatments and therapeutic algorithm. J Am Acad Dermatol 65: 925–941, 2011Zwischenberger BA, Jacobe HT. A systematic review of morphea treatments and therapeutic algorithm. J Am Acad Dermatol 65: 925–941, 2011Dytoc MT, Kossintseva I, Ting PT. First case series on the use of calcipotriol-betamethasone dipropionate for morphoea. Br J Dermatol. 2007;157(3):615–618. doi: 10.1111/j.1365-2133.2007.07971.xDytoc MT, Kossintseva I, Ting PT. First case series on the use of calcipotriol-betamethasone dipropionate for morphoea. Br J Dermatol. 2007;157(3):615–618. doi: 10.1111/j.1365-2133.2007.07971.xAhluwalia A. Topical glucocorticoids and the skin — mechanisms of action: an update. Mediators Inflamm. 1998;7(3):183–193. doi: 10.1080/09629359891126.Ahluwalia A. Topical glucocorticoids and the skin — mechanisms of action: an update. Mediators Inflamm. 1998;7(3):183–193. doi: 10.1080/09629359891126.Sapadin AN, Fleischmajer R. Treatment of scleroderma. Arch Dermatol. 2002;138(1):99–105. doi: 10.1001/archderm.138.1.99.Sapadin AN, Fleischmajer R. Treatment of scleroderma. Arch Dermatol. 2002;138(1):99–105. doi: 10.1001/archderm.138.1.99.Fett N, Werth VP. Update on morphea: part II. Outcome measures and treatment. J Am Acad Dermatol. 2011;64:231–242; quiz 243–244. doi: 10.1016/j.jaad.2010.05.046.Fett N, Werth VP. Update on morphea: part II. Outcome measures and treatment. J Am Acad Dermatol. 2011;64:231–242; quiz 243–244. doi: 10.1016/j.jaad.2010.05.046.Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol. 2002;46(2):228–241. doi: 10.1067/mjd.2002.120942.Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol. 2002;46(2):228–241. doi: 10.1067/mjd.2002.120942.Kroft EB, Groeneveld TJ, Seyger MM, de Jong EM. Efficacy of topical tacrolimus 0.1% in active plaque morphea: randomized, double-blind, emollient-controlled pilot study. Am J Clin Dermatol. 2009;10(9):181–187. doi: 10.2165/00128071-200910030-00004.Kroft EB, Groeneveld TJ, Seyger MM, de Jong EM. Efficacy of topical tacrolimus 0.1% in active plaque morphea: randomized, double-blind, emollient-controlled pilot study. Am J Clin Dermatol. 2009;10(9):181–187. doi: 10.2165/00128071-200910030-00004.Stefanaki C, Stefanaki K, Kontochristopoulos G, et al. Topical tacrolimus 0.1% ointment in the treatment of localized scleroderma. An open label clinical and histological study. J Dermatol. 2008;35:712–718. doi: 10.1111/j.1346-8138.2008.00552.x.Stefanaki C, Stefanaki K, Kontochristopoulos G, et al. Topical tacrolimus 0.1% ointment in the treatment of localized scleroderma. An open label clinical and histological study. J Dermatol. 2008;35:712–718. doi: 10.1111/j.1346-8138.2008.00552.x.Mancuso G, Berdondini RM. Topical tacrolimus in the treatment of localized scleroderma. Eur J Dermatol. 2003;13(6):590–592.Mancuso G, Berdondini RM. Topical tacrolimus in the treatment of localized scleroderma. Eur J Dermatol. 2003;13(6):590–592.Vidal D. Topical Imiquimod: Mechanism of Action and Clinical Applications. Mini Rev Med Chem. 2006;6(5), 499–503. doi: 10.2174/138955706776876131.Vidal D. Topical Imiquimod: Mechanism of Action and Clinical Applications. Mini Rev Med Chem. 2006;6(5), 499–503. doi: 10.2174/138955706776876131.Dytoc M, Ting PT, Man J, et al. First case series on the use of imiquimod for morphoea. Br J Dermatol. 2005;153(4):815–820. doi: 10.1111/j.1365-2133.2005.06776.x.Dytoc M, Ting PT, Man J, et al. First case series on the use of imiquimod for morphoea. Br J Dermatol. 2005;153(4):815–820. doi: 10.1111/j.1365-2133.2005.06776.x.Pope E, Doria AS, Theriault M, et al. Topical imiquimod 5% cream for pediatric plaque morphea: a prospective, multiple-baseline, open-label pilot study. Dermatology. 2011;223(4):363–369. doi: 10.1159/000335560.Pope E, Doria AS, Theriault M, et al. Topical imiquimod 5% cream for pediatric plaque morphea: a prospective, multiple-baseline, open-label pilot study. Dermatology. 2011;223(4):363–369. doi: 10.1159/000335560.Keyal U, Bhatta AK, Wang XL. UVA1 a promising approach for scleroderma. Am J Transl Res. 2017;9(9):4280–4287.Keyal U, Bhatta AK, Wang XL. UVA1 a promising approach for scleroderma. Am J Transl Res. 2017;9(9):4280–4287.Kreuter A, Hyun J, Stucker M, et al. A randomized controlled study of lowdose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma. J Am Acad Dermatol. 2006;54(3):440–447. doi: 10.1016/j.jaad.2005.11.1063.Kreuter A, Hyun J, Stucker M, et al. A randomized controlled study of lowdose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma. J Am Acad Dermatol. 2006;54(3):440–447. doi: 10.1016/j.jaad.2005.11.1063.Asano Y, Fujimoto M, Ishikawa O. Diagnostic criteria, severity classification and guidelines of localized scleroderma. J Dermatol. 2018;45(7):755–780. doi: 10.1111/1346-8138.14161.Asano Y, Fujimoto M, Ishikawa O. Diagnostic criteria, severity classification and guidelines of localized scleroderma. J Dermatol. 2018;45(7):755–780. doi: 10.1111/1346-8138.14161.Lythgoe H, Almeida B, Bennett J, et al. Multi-centre national audit of juvenile localised scleroderma: describing current UK practice in disease assessment and management. Pediatr Rheumatol Online J. 2018;16(1):80. doi: 10.1186/s12969-018-0295-0.Lythgoe H, Almeida B, Bennett J, et al. Multi-centre national audit of juvenile localised scleroderma: describing current UK practice in disease assessment and management. Pediatr Rheumatol Online J. 2018;16(1):80. doi: 10.1186/s12969-018-0295-0.Saxton-Daniels S, Jacobe HT An evaluation of long-term outcomes in adults with pediatric-onset morphea. Arch Dermatol. 2010;146(9):1044–1045. doi: 10.1001/archdermatol.2010.239.Saxton-Daniels S, Jacobe HT An evaluation of long-term outcomes in adults with pediatric-onset morphea. Arch Dermatol. 2010;146(9):1044–1045. doi: 10.1001/archdermatol.2010.239.Zulian F, Vallongo C, Patrizi A, et al. A long-term follow-up study of methotrexate in juvenile localized scleroderma (morphea). J Am Acad Dermatol. 2012;67(6):1151–1156. doi: 10.1016/j.jaad.2012.03.036.Zulian F, Vallongo C, Patrizi A, et al. A long-term follow-up study of methotrexate in juvenile localized scleroderma (morphea). J Am Acad Dermatol. 2012;67(6):1151–1156. doi: 10.1016/j.jaad.2012.03.036.Torok KS, Arkachaisri T. Methotrexate and corticosteroids in the treatment of localized scleroderma: a standardized prospective longitudinal single-center study. J Rheumatol. 2012;39(2):286–94. doi: 10.3899/jrheum.110210.Torok KS, Arkachaisri T. Methotrexate and corticosteroids in the treatment of localized scleroderma: a standardized prospective longitudinal single-center study. J Rheumatol. 2012;39(2):286–94. doi: 10.3899/jrheum.110210.Zulian F, Martini G, Vallongo C, et al. Methotrexate treatment in juvenile localized scleroderma: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2011;63(7):1998–2006. doi: 10.1002/art.30264.Zulian F, Martini G, Vallongo C, et al. Methotrexate treatment in juvenile localized scleroderma: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2011;63(7):1998–2006. doi: 10.1002/art.30264.Joly P, Bamberger N, Crickx B, et al. Treatment of severe forms of localized scleroderma with oral corticosteroids: follow-up study on 17 patients. Arch Dermatol. 1994;130(5):663–665.Joly P, Bamberger N, Crickx B, et al. Treatment of severe forms of localized scleroderma with oral corticosteroids: follow-up study on 17 patients. Arch Dermatol. 1994;130(5):663–665.Uziel Y, Feldman BM, Krafchik BR, et al. Methotrexate and corticosteroid therapy for pediatric localized scleroderma. J Pediatr. 2000;136(1):91–95. doi: 10.1016/s0022-3476(00)90056-8.Uziel Y, Feldman BM, Krafchik BR, et al. Methotrexate and corticosteroid therapy for pediatric localized scleroderma. J Pediatr. 2000;136(1):91–95. doi: 10.1016/s0022-3476(00)90056-8.Martini G, Ramanan AV, Falcini F, et al. Successful treatment of severe or methotrexate-resistant juvenile localized scleroderma with mycophenolate mofetil. Rheumatology. 2009;48(11):1410–1413. doi: 10.1093/rheumatology/kep244.Martini G, Ramanan AV, Falcini F, et al. Successful treatment of severe or methotrexate-resistant juvenile localized scleroderma with mycophenolate mofetil. Rheumatology. 2009;48(11):1410–1413. doi: 10.1093/rheumatology/kep244.Zulian F, Vallongo C, Woo P, et al. Localized scleroderma in childhood is not just a skin disease. Arthritis Rheum. 2005;52(9): 2873–2881. doi: 10.1002/art.21264.Zulian F, Vallongo C, Woo P, et al. Localized scleroderma in childhood is not just a skin disease. Arthritis Rheum. 2005;52(9): 2873–2881. doi: 10.1002/art.21264.Sheppard M, Laskou F, Stapleton PP, et al. Tocilizumab (Actemra). Hum Vaccin Immunother. 2017;13(9):1972–1988. doi: 10.1080/21645515.2017.1316909.Sheppard M, Laskou F, Stapleton PP, et al. Tocilizumab (Actemra). Hum Vaccin Immunother. 2017;13(9):1972–1988. doi: 10.1080/21645515.2017.1316909.Ihn H, Sato S, Fujimoto M, et al. Demonstrationмof interleukin-2, interleukin-4 and interleukin-6 in sera from patients with localized scleroderma. Arch Dermatol Res. 1995;287(2):193–197. doi: 10.1007/BF01262331.Ihn H, Sato S, Fujimoto M, et al. Demonstrationмof interleukin-2, interleukin-4 and interleukin-6 in sera from patients with localized scleroderma. Arch Dermatol Res. 1995;287(2):193–197. doi: 10.1007/BF01262331.Nagaoka T, Sato S, Hasegawa M, et al. Serum levels of soluble interleukin 6 receptor and soluble gp130 are elevated in patients with localized scleroderma. J Rheumatol. 2000;27(8):1917–1921.Nagaoka T, Sato S, Hasegawa M, et al. Serum levels of soluble interleukin 6 receptor and soluble gp130 are elevated in patients with localized scleroderma. J Rheumatol. 2000;27(8):1917–1921.Khanna D, Denton CP, Lin CJF, et al. Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: results from the openlabel period of a phase II randomised controlled trial (faSScinate). Ann Rheum Dis. 2018;77(2):212–220. doi: 10.1136/annrheumdis-2017-211682.Khanna D, Denton CP, Lin CJF, et al. Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: results from the openlabel period of a phase II randomised controlled trial (faSScinate). Ann Rheum Dis. 2018;77(2):212–220. doi: 10.1136/annrheumdis-2017-211682.Foeldvari I, Anton Lopez J, Friswell M, et al. Tocilizumab is a promising treatment option for therapy resistant juvenile localized scleroderma. J Scleroderma Relat Disord. 2017;2(3):203–207. doi: 10.5301/jsrd.5000259.Foeldvari I, Anton Lopez J, Friswell M, et al. Tocilizumab is a promising treatment option for therapy resistant juvenile localized scleroderma. J Scleroderma Relat Disord. 2017;2(3):203–207. doi: 10.5301/jsrd.5000259.Martini G, Campus S, Raffeiner B, et al. Tocilizumab in two children with pansclerotic morphoea: a hopeful therapy for refractory cases? Clin Exp Rheumatol. 2017;35 Suppl 106(4):211–213.Martini G, Campus S, Raffeiner B, et al. Tocilizumab in two children with pansclerotic morphoea: a hopeful therapy for refractory cases? Clin Exp Rheumatol. 2017;35 Suppl 106(4):211–213.Lythgoe H, Baildam E, Beresford MW, et al. Tocilizumab as a potential therapeutic option for children with severe, refractory juvenile localized scleroderma. Rheumatology (Oxford). 2018; 57(2):398–401. doi: 10.1093/rheumatology/kex382.Lythgoe H, Baildam E, Beresford MW, et al. Tocilizumab as a potential therapeutic option for children with severe, refractory juvenile localized scleroderma. Rheumatology (Oxford). 2018; 57(2):398–401. doi: 10.1093/rheumatology/kex382.Dubois EA, Cohen AF. Abatacept. Br J Clin Pharmacol. 2009; 68(4):480–481. doi: 10.1111/j.1365-2125.2009.03502.x.Dubois EA, Cohen AF. Abatacept. Br J Clin Pharmacol. 2009; 68(4):480–481. doi: 10.1111/j.1365-2125.2009.03502.x.Bruni C, Praino E, Allanore Y, et al. Use of biologics and other novel therapies for the treatment of systemic sclerosis. Expert Rev Clin Immunol. 2017;13(5):469–482. doi: 10.1080/1744666X.2017.1263153.Bruni C, Praino E, Allanore Y, et al. Use of biologics and other novel therapies for the treatment of systemic sclerosis. Expert Rev Clin Immunol. 2017;13(5):469–482. doi: 10.1080/1744666X.2017.1263153.Brunner HI, Tzaribachev N, Vega-Cornejo G, et al. Subcutaneous abatacept in patients with polyarticular-course juvenile idiopathic arthritis: results from a phase III open-label study. Arthritis Rheumatol. 2018;70(7):1144–1154. doi: 10.1002/art.40466.Brunner HI, Tzaribachev N, Vega-Cornejo G, et al. Subcutaneous abatacept in patients with polyarticular-course juvenile idiopathic arthritis: results from a phase III open-label study. Arthritis Rheumatol. 2018;70(7):1144–1154. doi: 10.1002/art.40466.Khanna D, Spino C, Johnson S, et al. Abatacept in early diffuse cutaneous systemic sclerosis— results of a phase 2 investigatorinitiated, multicenter, double- blind randomized placebo-controlled trial. Arthritis Rheumatol. 2020;72(1):125–136. doi: 10.1002/art.41055.Khanna D, Spino C, Johnson S, et al. Abatacept in early diffuse cutaneous systemic sclerosis— results of a phase 2 investigatorinitiated, multicenter, double- blind randomized placebo-controlled trial. Arthritis Rheumatol. 2020;72(1):125–136. doi: 10.1002/art.41055.Fage SW, Arvesen KB, Olesen AB. Abatacept improves skin score and reduces lesions in patients with localized scleroderma: a case series. Acta Derm Venereol. 2018;98(4):465–466. doi: 10.2340/00015555-2878.Fage SW, Arvesen KB, Olesen AB. Abatacept improves skin score and reduces lesions in patients with localized scleroderma: a case series. Acta Derm Venereol. 2018;98(4):465–466. doi: 10.2340/00015555-2878.Chimenti MS, Teoli M, Di Stefani A, et al. Resolution with rituximab of localized scleroderma occurring during etanercept treatment in a patient with rheumatoid arthritis. Eur J Dermatol. 2013;23(2):273–274. doi: 10.1684/ejd.2013.1929.Chimenti MS, Teoli M, Di Stefani A, et al. Resolution with rituximab of localized scleroderma occurring during etanercept treatment in a patient with rheumatoid arthritis. Eur J Dermatol. 2013;23(2):273–274. doi: 10.1684/ejd.2013.1929.Ferguson ID, Weiser P, Torok KS. A case report of successful treatment of recalcitrant childhood localized scleroderma with infliximab and leflunomide. Open Rheumatol J. 2015;9:30–35. doi: 10.2174/18743129014090100030.Ferguson ID, Weiser P, Torok KS. A case report of successful treatment of recalcitrant childhood localized scleroderma with infliximab and leflunomide. Open Rheumatol J. 2015;9:30–35. doi: 10.2174/18743129014090100030.Alcantara-Reifs CM, Garnacho-Saucedo GM, Salido-Vallejo R, et al. Imatinib treatment of therapy resistant generalized deep morphea. Dermatol Ther. 2015;28(5):271–273. doi: 10.1111/dth.12248.Alcantara-Reifs CM, Garnacho-Saucedo GM, Salido-Vallejo R, et al. Imatinib treatment of therapy resistant generalized deep morphea. Dermatol Ther. 2015;28(5):271–273. doi: 10.1111/dth.12248.Schoch JJ, Schoch BS, Werthel JD, et al. Orthopedic complications of linear morphea: Implications for early interdisciplinary care. Pediatr Dermatol. 2017;35(1):43–46. doi: 10.1111/pde.13336.Schoch JJ, Schoch BS, Werthel JD, et al. Orthopedic complications of linear morphea: Implications for early interdisciplinary care. Pediatr Dermatol. 2017;35(1):43–46. doi: 10.1111/pde.13336.Torok KS. Pediatric scleroderma: systemic or localized forms. Pediatr Clin N Am. 2012;59:381–405. doi: 10.1016/j.pcl.2012.03.011.Torok KS. Pediatric scleroderma: systemic or localized forms. Pediatr Clin N Am. 2012;59:381–405. doi: 10.1016/j.pcl.2012.03.011.Mugii N, Matsushita T, Oohata S, et al. Long-term follow-up of finger passive range of motion in Japanese systemic sclerosis patients treated with self-administered stretching. Mod Rheumatol. 2019;29(3):484–490. doi: 10.1080/14397595.2018.1466635.Mugii N, Matsushita T, Oohata S, et al. Long-term follow-up of finger passive range of motion in Japanese systemic sclerosis patients treated with self-administered stretching. Mod Rheumatol. 2019;29(3):484–490. doi: 10.1080/14397595.2018.1466635.Buckley SL, Skinner S, James P, Ashley RK. Focal scleroderma in children: an orthopaedic perspective. J Pediatr Orthop. 1993;13(6):784–790. doi: 10.1097/01241398-199311000-00020.Buckley SL, Skinner S, James P, Ashley RK. Focal scleroderma in children: an orthopaedic perspective. J Pediatr Orthop. 1993;13(6):784–790. doi: 10.1097/01241398-199311000-00020.Ghanem I, Karam JA, Widmann RF. Surgical epiphysiodesis indications and techniques: update. Curr Opin Pediatr. 2011;23(1): 53–59. doi: 10.1097/MOP.0b013e32834231b3.Ghanem I, Karam JA, Widmann RF. Surgical epiphysiodesis indications and techniques: update. Curr Opin Pediatr. 2011;23(1): 53–59. doi: 10.1097/MOP.0b013e32834231b3.Daumas A, Magalon J, Delaunay F, et al. Fat Grafting for Treatment of Facial Scleroderma. Clin Plast Surg. 2020;47(1): 155–163. doi: 10.1016/j.cps.2019.08.016.Daumas A, Magalon J, Delaunay F, et al. Fat Grafting for Treatment of Facial Scleroderma. Clin Plast Surg. 2020;47(1): 155–163. doi: 10.1016/j.cps.2019.08.016.Strong AL, Rubin JP, Kozlow JH, Cederna PS. Fat Grafting for the Treatment of Scleroderma. Plast Reconstr Surg. 2019;144(6): 1498–1507. doi: 10.1097/PRS.0000000000006291.Strong AL, Rubin JP, Kozlow JH, Cederna PS. Fat Grafting for the Treatment of Scleroderma. Plast Reconstr Surg. 2019;144(6): 1498–1507. doi: 10.1097/PRS.0000000000006291.Palmero ML, Uziel Y, Laxer RM, et al. En coup de sabre scleroderma and Parry-Romberg syndrome in adolescents: surgical options and patient-related outcomes. J Rheumatol. 2010;37(10): 2174–2179. doi: 10.3899/jrheum.100062.Palmero ML, Uziel Y, Laxer RM, et al. En coup de sabre scleroderma and Parry-Romberg syndrome in adolescents: surgical options and patient-related outcomes. J Rheumatol. 2010;37(10): 2174–2179. doi: 10.3899/jrheum.100062.Wollina U, Buslau M, Heinig B, et al. Disabling pansclerotic morphea of childhood poses a high risk of chronic ulceration of the skin and squamous cell carcinoma. Int J Low Extrem Wounds. 2007;6(4):291–298. doi: 10.1177/1534734607308731.Wollina U, Buslau M, Heinig B, et al. Disabling pansclerotic morphea of childhood poses a high risk of chronic ulceration of the skin and squamous cell carcinoma. Int J Low Extrem Wounds. 2007;6(4):291–298. doi: 10.1177/1534734607308731.Piram M, McCuaig CC, Saint-Cyr C, et al. Short- and long-term outcome of linear morphoea in children. Br J Dermatol. 2013; 169(6):1265–1271. doi: 10.1111/bjd.12606.Piram M, McCuaig CC, Saint-Cyr C, et al. Short- and long-term outcome of linear morphoea in children. Br J Dermatol. 2013; 169(6):1265–1271. doi: 10.1111/bjd.12606.Ardalan K, Zigler C, Torok K. Predictors of longitudinal quality of life in juvenile localized scleroderma. Arthritis Care Res. 2017; 69(7):1082–1087. doi: 10.1002/acr.23101.Ardalan K, Zigler C, Torok K. Predictors of longitudinal quality of life in juvenile localized scleroderma. Arthritis Care Res. 2017; 69(7):1082–1087. doi: 10.1002/acr.23101.

The authors declare that there are no conflicts of interest present.