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

• Published in: Journal of the American Academy of Dermatology 2014-09, Vol.71 (3), p.493-498
• Main Authors: Grabell, Daniel, MBA, Hsieh, Clifford, BS, Andrew, Rachel, MD, Martires, Kathryn, MD, Kim, Andrew, MD, Vasquez, Rebecca, MD, Jacobe, Heidi, MD, MSCS
• Format: Article
• Language: English
• Subjects: Adult; Cohort Studies; Cross-Sectional Studies; Dermatology; Dermatology Life Quality Index; Female; Humans; localized scleroderma; Male; Middle Aged; modified Rodnan Skin Score; morphea; Morphea in Adults and Children cohort; Phototherapy; Quality of Life; Scleroderma, Localized - etiology; Scleroderma, Localized - therapy; Severity of Illness Index; Skin - injuries; skin trauma
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2014.04.009

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.