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. 2014 Sep;71(3):493-8.
doi: 10.1016/j.jaad.2014.04.009. Epub 2014 May 28.

The role of skin trauma in the distribution of morphea lesions: a cross-sectional survey of the Morphea in Adults and Children cohort IV

Daniel Grabell  1 , Clifford Hsieh  2 , Rachel Andrew  1 , Kathryn Martires  3 , Andrew Kim  4 , Rebecca Vasquez  1 , Heidi Jacobe  5
Affiliations

The role of skin trauma in the distribution of morphea lesions: a cross-sectional survey of the Morphea in Adults and Children cohort IV

Daniel Grabell et al. J Am Acad Dermatol. 2014 Sep.

Abstract

Background: Skin trauma may play a role in the development of morphea lesions. The association between trauma and the distribution of cutaneous lesions has never been examined to our knowledge.

Objective: We sought to determine whether patients enrolled in the Morphea in Adults and Children (MAC) cohort exhibit skin lesions distributed in areas of prior (isotopic) or ongoing (isomorphic) trauma.

Methods: This was a cross-sectional analysis of the MAC cohort.

Results: Of 329 patients in the MAC cohort, 52 (16%) had trauma-associated lesions at the onset of disease. Patients with lesions in an isotopic distribution had greater clinical severity as measured by a clinical outcome measure (mean modified Rodnan Skin Score of 13.8 vs 5.3, P = .004, 95% confidence interval 3.08-13.92) and impact on life quality (mean Dermatology Life Quality Index score 8.4 vs 4.1, P = .009, 95% confidence interval 1.18-7.50) than those with an isomorphic distribution. Most frequent associated traumas were chronic friction (isomorphic) and surgery/isotopic.

Limitations: Recall bias for patient-reported events is a limitation.

Conclusion: Of patients in the MAC cohort, 16% developed initial morphea lesions at sites of skin trauma. If these findings can be confirmed in additional series, they suggest that elective procedures and excessive skin trauma or friction might be avoided in these patients.

Keywords: Dermatology Life Quality Index; Morphea in Adults and Children cohort; localized scleroderma; modified Rodnan Skin Score; morphea; skin trauma.

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Conflict of interest statement

Conflict of Interest Disclosure: The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Isotopic morphea on the right leg. The solid arrow points to a surgical scar where the lesion began.
Figure 2
Figure 2
a: Isomorphic morphea in the brassiere line of a Caucasian female undergoing phototherapy b: Isomorphic morphea in the waist band and inguinal areas in the same patient.
Figure 2
Figure 2
a: Isomorphic morphea in the brassiere line of a Caucasian female undergoing phototherapy b: Isomorphic morphea in the waist band and inguinal areas in the same patient.
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