The effects of a Vitamin D analogue (calcipotriene) on morphea, a fibrosing skin condition

Morphea is a skin disorder that leads to skin thickening that may result in itching and profound functional impairment like leg length discrepancies and/or cosmetic impairment like facial disfigurement. Morphea also is known as localized scleroderma because the skin findings resemble those found in patients with a separate disease called systemic sclerosis (systemic scleroderma). Morphea affects children and adults though most commonly targets girls and women; the ratio of women to men in adults is 2.6-4:1 and in children the girl to boy ratio is 1.9-2.7:1. The causes of morphea and scleroderma are poorly understood, but the disorders share similar features including hardening of the skin. Although small studies in patients with morphea suggest that calcipotriene ointment, a Vitamin D3 analogue, may help to soften the skin, there have been no conclusive studies conducted to date to determine which patients are most likely to benefit from this therapy. Further, the way in which calcipotriene acts to soften skin is unknown. Using the resources of the Northwestern Skin Disease Research Center and the Northwestern Scleroderma Program, we propose a novel study to investigate the gene expression of patients before and after treatment with calcipotriene. We plan to find molecular pathways in skin that differ in patients before and after treatment and correlate these with patient response. The results of these experiments are important because they will enable us to discover novel molecular pathways that underlie the disease and this may lead to identification of novel treatments. Secondly, we will identify gene expression signatures in skin that may be useful in identifying which patients will respond to calcipotriene treatment.