Diagnostic Tool for Morphea Severity Found to be Effective for Pediatric Patients

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Research was conducted into the development of a tool for assessing morphea disease severity in pediatric patients.

The newly-developed Morphea Activity Measure (MAM) was found to be a useful clinical tool for determining pediatric morphea severity, according to new findings.1

The findings were the result of a new diagnostic study into the design of a new morphea severity tool, as measuring the inflammatory disease’s severity is difficult and its progression is often unclear.

This lack of clear data on morphea’s severity often leads to outcomes such as delayed diagnosis and even undertreatment, which the researchers in this study sought to address.

The study was authored by Maria Teresa García-Romero, MD, MPH, from the Department of Dermatology at the National Institute of Pediatrics in Mexico City.

“There is a need for an objective validated measure of morphea activity that consists of more clinical features, includes assessment of body surface area (BSA), can be applied to morphea of any type or severity, and is easy to use in clinical and research settings,” García-Romero and colleagues wrote. “...we aimed to develop a new morphea skin-specific instrument, the Morphea Activity Measure (MAM), and assess its reliability, validity, and viability.”

Research and Methods

The investigators designed the pilot diagnostic study to be split into 2 pieces over its course: the development phase and the validation phase. Overall, both phases lasted from September of 2019 to March of 2020.

The team used 14 experts on morphea—made up of both pediatric and regular dermatologists—who utilized a Delphi consensus method for the items under consideration to be added to the MAM in the development of the diagnostic tool.

As this phase commenced, the experts evaluated online survey items through the use of a Likert scale. The Likert scale score range was 0 to 10, with 0 being labeled unimportant and 10 being quite important.

The investigators defined agreement as being a median score of 7.0 or more, disagreement as being a median score of 3.9 or less, and a non-consensus as being a median score of 4.0-6.9.

Eight total investigators worked to evaluate the MAM in the validation phase with 14 pediatric morphea patients who had been drawn from the referral center at the Medical College of Washington.

The team of investigators evaluated the tool’s validity, viability, and reliability, and they used descriptive statistics for quantitative variables as well.

Study Results

The study concluded the development half of the study following 2 rounds of research, with the final severity-assessment tool being made up of 10 items which had been found to be indicative of the inflammatory skin condition.

In the researchers’ validation half of the study, they noted that the intraclass correlation coefficients were 0.856 (95% CI, 0.791 to 0.901) in the intrarater agreement and 0.844 (95% CI, 0.681 to 0.942) in the interrater agreement.

The team also noted somewhat strong correlations between their modified Localized Scleroderma Severity Index system (Spearman ρ = 0.747; P< .001) and the MAM, as well as strong correlations between the Physician Global Assessment of Activity (Spearman ρ = 0.729; P< .001) and the MAM.

During their interviews in which they assessed qualitative aspects, the MAM’s evaluators confirmed that the tool was relatively simple to use, did assess the severity of morphea activity at one single point in time, and that it should be responsive to morphea disease activity changes over time.

“In this study, the MAM was found to be a reliable, valid, and viable tool to measure pediatric morphea activity,” they wrote. “Further testing to assess validity in adults and responsiveness to change is needed.”


  1. García-Romero MT, Tollefson M, Pope E, et al. Development and Validation of the Morphea Activity Measure in Patients With Pediatric Morphea. JAMA Dermatol. Published online February 08, 2023. doi:10.1001/jamadermatol.2022.6365