Fig. 9.

Flow chart for the management of morphea and eosinophilic fasciitis. * Topical Corticosteroids (TCS): moderately potent TCS once daily for 3 months. Highly potent TCS once daily for 1 month. ** Topical calcipotriol 0.005% ointment: once or twice daily, with or without occlusion. Possibly in combination with TCS. *** Topical tacrolimus 0.1% ointment: once or twice daily, with or without occlusion. Possibly in combination with TCS. ^† Phototherapy: preferably UVA1; suggested dose: 60 J/cm² to a cumulative dose of 1460 J/cm². If UVA1 is unavailable or impractical, alternative modalities are broadband UVA, PUVA or UVB. Methotrexate (MTX): adult starting dose 15 mg/week, max dose 25 mg/week; pediatric starting dose 15 mg/m², max dose 25 mg. Folic acid supplementation: 0.4–1 mg/day or 5–10 mg/week. Systemic corticosteroids (SCS): adult starting dose 0.5–1 mg/kg/day (max 60 mg) during a max of 3 months followed by tapering; pediatric dose: 1–2 mg/kg/day, max dose 60mg/day, followed by tapering. Intravenous methylprednisolone (IVMP): adult dose 1000 mg/day for 3 days/month for 3–6 months, possibly followed by oral SCS. Pediatric dose 30 mg/kg/day for 3 days/month for 3 months, possibly followed by oral SCS. ^α Mycophenolate Mofetil (MMF, alternative to MTX): adult dose 1000 mg twice daily. Pediatric dose 600–1200 mg/m²/day twice daily. ^A Deep/linear subtypes: treatment with MTX monotherapy. Addition of SCS or IVMP in case of rapidly progressive disease or in the presence of (looming) contractures. ^B Eosinophilic Fasciitis: standard induction treatment with oral SCS or IVMP in combination with MTX . PUVA psoralen plus broadband UVA, UV ultraviolet