Daniel Grabell1, Clifford Hsieh2, Rachel Andrew1, Kathryn Martires3, Andrew Kim4, Rebecca Vasquez1, Heidi Jacobe5. 1. Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. 2. Pritzker School of Medicine, University of Chicago, Chicago, Illinois. 3. Department of Dermatology, Kaiser Permanente, Los Angeles, California. 4. Department of Medicine, Lenox Hill Hospital, New York, New York. 5. Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: heidi.jacobe@utsouthwestern.edu.
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.
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
Authors: P Clements; P Lachenbruch; J Siebold; B White; S Weiner; R Martin; A Weinstein; M Weisman; M Mayes; D Collier Journal: J Rheumatol Date: 1995-07 Impact factor: 4.666
Authors: Jorre S Mertens; Marieke M B Seyger; Rogier M Thurlings; Timothy R D J Radstake; Elke M G J de Jong Journal: Am J Clin Dermatol Date: 2017-08 Impact factor: 7.403