One of the most pressing concerns of morphea patients and caregivers is concern that morphea will "progress" into systemic scleroderma, and few people feel very reassured by hearing that it "almost never" happens. Just the slightest chance that it could happen is disarming to some and very worrisome to others.

A great article on this topic is in ISN's book, Voices of Scleroderma Volume 2 by Dr. Vanessa Malcarne, entitled, Developing Empathy: A Researcher's Perspective on Being Diagnosed with Scleroderma, pages 177-181.

When it comes down to it, nobody can guarantee a morphea patient that they will never develop other symptoms or illnesses in their lifetime, especially since the bottom line is that eventually everyone dies. And if there is the slightest chance something more serious might be associated with an illness or symptom, most of us would want to know about it.

Generally speaking, research indicates that about 75% of people with morphea do not have additional symptoms or any other illness. However, about 25% may develop one or two symptoms outside of morphea, and about 2% or less—particularly, those with anti-centromere (ACA) antibodies—may be at risk of also developing systemic scleroderma, or have morphea along with some other serious disease.

Therefore, with morphea you don't need to be always on guard for signs of trouble nor feel doomed to develop other serious symptoms or diseases. It is reasonable to take precautions such as having an annual physical and to report any new signs or symptoms to your medical team, the same as you would whether or not you had morphea.

After all, the odds are 75% of the people with morphea will not develop additional problems, and 98% likelihood that they will not develop systemic scleroderma—and although 2% is a very slight risk, it is still many times greater than that of people who do not have morphea.

Perhaps the greatest hazard is that a patient or caregiver may become obsessed or depressed or hypervigilant about the possibility of developing further symptoms, and thus complicate things with anxiety, depression or rounds of endless and unproductive medical tests. Usually, reasonable medical care, solid information and support are enough to overcome a temporary reaction such as this.

The general rule of thumb is that if feelings of anxiety, uneasiness, depression, or obsession with health thoughts last more than two weeks, then it is time to consult medical advisers for help in combatting the sense of dis-ease, which can often be worse than the ailment itself and lead to things such as insomnia or oversleeping, edginess, fatigue, eating changes, or depressed mood.

While it is healthy to gain information and knowledge about an illness and even its potential complications from responsible sources, it is unhealthy to dwell on it for extended periods of time, to lose interest in daily activities, or to not be able to put it in perspective.

Our advice? It's reasonable to have some concern, but not to worry endlessly over it. Polish your flexible mental attitude with the confidence of being able to "roll with the punches" of whatever life delivers. There are no guarantees for any of us in life. Although it sounds trite, there are always people worse off than we are, and focusing on others in a worse plight is a healthier way to cope than to reduce our inner world to only our own concerns.

Don't hesitate to seek professional guidance if you need help adjusting to the effects of morphea. Few of us are born with all the coping mechanisms necessary to adjust with great aplomb to significant changes in our looks, abilities, or health that morphea can impose through effects on the skin, underlying joints, or even from the side effects of treatments.

An interesting thing that occurs with morphea, though, is that well-meaning doctors and others are likely to phrase it that you are "lucky" because systemic scleroderma is so much worse. Bah humbug! Nobody is "lucky" to have any illness, even one that is usually mild and self-limiting. Everyone with any symptom or illness has their own cross to bear. Don't feel obliged to be grateful for not having systemic or other awful illnesses. There's plenty enough to deal with, without that!

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