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

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. Objective 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 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=0.004, 95% CI=3.08-13.92) and impact on life quality (mean Dermatology Life Quality Index 8.4 vs. 4.1, P=0.009, 95% CI 1.18-7.50) than those with an isomorphic distribution. Most frequent associated trauma were chronic friction (isomorphic) and surgery/isotopic. Limitations Recall bias for patient reported events. Conclusion Sixteen percent of patients in the MAC cohort 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.

Histopathological changes in morphea and their clinical correlates: Results from the Morphea in Adults and Children Cohort V

“…In patients with isomorphic morphea (which our group described previously) top heavy patterns of sclerosis predominated. 15 Isomorphic lesions occur in sights of chronic friction (waistband area). The superficial distribution of histological changes in isomorphic morphea further supports chronic superficial trauma in the pathogenesis of these lesions.…”

“…Clinical subtypes included circumscribed, linear, generalized, profunda, and morphea with lichen sclerosus features (as previously defined). 13, 14 Two generalized morphea subgroups were assigned including isomorphic (lesions occurring in areas of friction: waistline, etc; more common in older, post-menopausal women) 15 and symmetrical morphea (lesions arranged symmetrically about the anatomical midline.…”

The molecular pathogenesis of morphoea: from genetics to future treatment targets

“…An array of environmental triggers is widely reported in the aetiology of morphoea, seemingly linking susceptibility mechanisms and eventual, but not inevitable, disease onset (see Figs and ) . Trauma, in the form of insect bites, injection/vaccination, repeated friction, surgery, penetrating trauma, radiotherapy and extreme exercise, may trigger morphoea in up to 16% of adults and 9% of children . Trauma‐related morphoea may occur at the affected site, or a more systemic response may be triggered, with site‐unrelated skin sclerosis also seen.…”

Localized Scleroderma: Predisposing and Triggering Factors

“…The question of the possibility of quiescent period in the development of scleroderma was discussed [24]. The cross-sectional analysis of the localized scleroderma in adults and children cohort (MAC) was performed by Grabell D & colleagues, (2014) [25]. 52 (16%) among 329 patients in the MAC cohort had trauma-associated lesions at the onset of disease.…”

“…52 (16%) among 329 patients in the MAC cohort 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 [25]. Another crosssectional survey of the MAC cohort emphasized the role of skin trauma [26].…”