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The role of skin trauma in the distribution of morphea lesions: A cross-sectional survey of the Morphea in Adults and Children cohort IV - 14/08/14

Doi : 10.1016/j.jaad.2014.04.009 
Daniel Grabell, MBA a, Clifford Hsieh, BS b, Rachel Andrew, MD a, Kathryn Martires, MD c, Andrew Kim, MD d, Rebecca Vasquez, MD a, Heidi Jacobe, MD, MSCS a,
a Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas 
b Pritzker School of Medicine, University of Chicago, Chicago, Illinois 
c Department of Dermatology, Kaiser Permanente, Los Angeles, California 
d Department of Medicine, Lenox Hill Hospital, New York, New York 

Correspondence to: Heidi Jacobe, MD, MSCS, Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9069.

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.

Le texte complet de cet article est disponible en PDF.

Key words : Dermatology Life Quality Index, localized scleroderma, modified Rodnan Skin Score, morphea, Morphea in Adults and Children cohort, skin trauma

Abbreviations used : DLQI, GVHD, MAC, mRSS, QOL


Plan


 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.


© 2014  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 71 - N° 3

P. 493-498 - septembre 2014 Retour au numéro
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