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

https://doi.org/10.1016/j.jaad.2014.04.009Get rights and content

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.

Section snippets

Patients

The institutional review board–approved MAC cohort contained 329 adults (≥18 years old at enrollment) and children (≤17 years old at enrollment) as of March 2012. Patients were prospectively recruited from within the University of Texas Southwestern Medical Center system and from private practitioners providing patients of varied disease severity, subtypes, and socioeconomic backgrounds. Criteria for inclusion in this study included: eligibility for enrollment in the MAC cohort, age 4 years or

Results

Of the 329 patients in the MAC cohort, a total of 52 (16%) met the inclusion criteria: 21 (6%) isotopic and 31 (9%) isomorphic. Patients (n = 277) were excluded from the study because of the following: age younger than 4 years (n = 9), insufficient data on variables of interest (n = 29), indeterminate subtype (n = 8), and lack of inciting event or isomorphic distribution of lesions (n = 231). The demographics of the patients included in the study are shown in Table I. The mean age of onset for

Discussion

The objective of this cross-sectional study was to determine the frequency of skin trauma-associated lesions in the MAC cohort and the associated demographic and clinical features in these patients. We found that of 329 patients, 52 (16%) had evidence for skin trauma or friction in the clinical distribution of skin lesions at the onset of disease. This was present most frequently in adults with the subtype of generalized morphea (Table II) implicating the possibility of an isotopic/isomorphic

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Research for this manuscript was supported in part by National Institutes of Health (NIH) Grant No. K23AR056303-4. This work was conducted with support from UT-STAR, NIH/National Center for Research Resources (NCRR)/National Center for Advancing Translational Sciences Grant No. UL1RR024982. The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, University of Texas Southwestern Medical Center at Dallas and its affiliated academic and health care centers, the NCRR, or the NIH.

Conflicts of interest: None declared.

Reprints not available from the authors.

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