If methotrexate is contraindicated or not tolerated, what systemic treatments do you use for generalized morphea?

I typically reach for mycophenolate as a second-line agent if methotrexate failed or is contraindicated. If the generalized morphea is actively progressing, I will add a steroid taper as a bridge until the DMARD has time to take effect. Whole body UVA1 is also a helpful adjunctive treatment to a DMA...

I agree with mycophenolate. Since UVA1 is difficult to find/use, we have done more nbUVB and have found this helpful for many, if not most, patients, and it can be used as an adjuvant with MMF (or mtx). Also agree with considering the bridge with prednisone. Would also suggest looking closely at wha...

I assume they failed hydroxychloroquine.

I have, in the past, used Azathioprine with partial benefit.

There is no definitive treatment for Morphea. I suppose other DMARDs can be tried as well.