{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:51:52Z","timestamp":1784206312791,"version":"3.55.0"},"reference-count":6,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>Localized scleroderma, or morphea, is a chronic fibrosing skin condition with limited therapeutic options, particularly for patients who are elderly, immunocompromized, or intolerant to systemic immunosuppressants. We present three adult patients with severe, treatment-refractory localized scleroderma who demonstrated rapid and substantial clinical improvement following initiation of topical roflumilast 0.3% cream under occlusion. All patients had failed or declined systemic therapy. Within 6\u201312\u2009weeks, each showed marked reductions in inflammatory activity, pain, and skin induration, as measured by validated clinical scores (Localized Scleroderma Activity Index, Physician\u2019s Global Assessment of Activity\/Damage). No adverse events were reported. Roflumilast, a potent phosphodiesterase-4 inhibitor with anti-inflammatory and antifibrotic properties, may offer a well-tolerated, nonimmunosuppressive treatment option in morphea. This is the first reported case series using topical roflumilast in localized scleroderma and supports further investigation of phosphodiesterase-4 inhibition as a therapeutic strategy in fibrosing skin disease.<\/jats:p>","DOI":"10.1177\/2050313x251406440","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T07:37:39Z","timestamp":1765870659000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Phosphodiesterase-4 inhibition in localized scleroderma: A case series of topical roflumilast"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4845-5770","authenticated-orcid":false,"given":"Ghassan","family":"Barnawi","sequence":"first","affiliation":[{"name":"Division of Dermatology, Department of Medicine, McGill University Health Centre, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0585-1546","authenticated-orcid":false,"given":"Alexandra Carla","family":"Bobica","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, McGill University, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hessah","family":"BinJadeed","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, McGill University Health Centre, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9263-1306","authenticated-orcid":false,"given":"Stephanie","family":"Ghazal","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, McGill University Health Centre, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6692-7787","authenticated-orcid":false,"given":"Elena","family":"Netchiporouk","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, McGill University Health Centre, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26031258"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2020.5809"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14236"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.15632"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2021.11.009"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2024-004704"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X251406440","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X251406440","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X251406440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T19:41:50Z","timestamp":1769370110000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X251406440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":6,"alternative-id":["10.1177\/2050313X251406440"],"URL":"https:\/\/doi.org\/10.1177\/2050313x251406440","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"article-number":"2050313X251406440"}}