Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Dermatology Venerology

Background: Morphea is a rare fibrosing disorder of the skin that results from a state of imbalance between collagen production and destruction leading to overproduction of abnormal thickened collagen bundles. Although UVA1 is a well established mode of therapy as regards efficacy and safety profile, but with limited feasibility to patients due to need of multiple sessions per week, in addition to the cosmetically unacceptable UVA1 induced hyperpigmentation. Fractional ablative laser resurfacing has been effectively used in scar treatment, where it restored the normal physiological balance in treated areas via abnormal collagen degradation and new collagen synthesis, thus fractional ablative laser can provide an effective modality in treatment of cases of morphea. Aim of work: To evaluate the efficacy of the fractional carbon dioxide laser as a new modality for treatment of localized scleroderma and to compare its results with the well established method of UVA1 phototherapy. Patients and methods: Seventeen patients with plaque and linear morphea were included. Each was subjected to complete medical history and thorough examination. Two comparable morphea lesions were randomly assigned to the UVA-1 phototherapy (30 sessions over 10 weeks) and fractional CO2 laser (3 monthly sessions). Evaluation was done clinically and histopathologically using validated scoring systems. Immunhistochemical analysis of TGF-ß1 and MMP1 was done. In addition, assessment of dermal thickness pre and post treatment was evaluated via ultrasound biomicroscopy for a sample of patients

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