Pediatric Drugs

, Volume 21, Issue 6, pp 461–467 | Cite as

Update on the Systemic Treatment of Pediatric Localized Scleroderma

  • Ivan FoeldvariEmail author
Review Article


Juvenile localized scleroderma (jLS) is an orphan disease that can lead to cosmetic disfiguration and orthopedic problems. Two recent publications review the current recommendations regarding diagnosis, assessment, follow up and treatment of pediatric localized scleroderma cases, both of which suggest the Localized Scleroderma Cutaneous Assessment Tool as an important instrument to assess activity and damage. This review focuses on the systemic treatment of jLS. Systemic treatment includes synthetic and biologic disease-modifying antirheumatic drugs. Systemic therapy is indicated if the lesion crosses any joint, or leads to potential cosmetic disfiguration or orthopedic problems. The only controlled trial of systemic treatment has shown the efficacy of methotrexate, which is the first choice of treatment. It appears superior to phototherapy according to a recently published meta-analysis. In case of methotrexate intolerance, mycophenolate mofetil is an option. In case of methotrexate nonresponse, addition of mycophenolate mofetil, tocilizumab or abatacept seems to be effective. Future treatment options derived and extrapolated from adult trials regarding treatment of skin involvement of systemic scleroderma or fibrosis are promising, as the final pathway in the skin seems to be similar in both diseases.



I thank Dr. Hanna Lythgoe from University Children’s Hospital in Manchester, UK for the thoughtful language review.

Compliance with Ethical Standards


No funding was received for the preparation of this review.

Conflict of interest

In the last 2 years, the author was a participant of an advisory board of Pfizer, Novartis, and BMS and worked as an advisor for Genentech, Bayer, Lilly, MEDAC, Sanofi, and Inventa.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Hamburg Centre for Pediatric and Adolescence Rheumatology, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence, Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, BudapestAn der Schön Klinik Hamburg-EilbekHamburgGermany

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