title: 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 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.
  
  
  CONCLUSIONS
  Recall bias for patient-reported events is a limitation.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grabell
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Clifford
authors.initials: C
authors.lastname: Hsieh
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rachel
authors.initials: R
authors.lastname: Andrew
authors.affiliation: Department of Dermatology, Kaiser Permanente, Los Angeles, California.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Martires
authors.affiliation: Department of Medicine, Lenox Hill Hospital, New York, New York.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Vasquez
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: heidi.jacobe@utsouthwestern.edu.
authors.forename: Heidi
authors.initials: H
authors.lastname: Jacobe
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010789:Phototherapy; D011788:Quality of Life; D012594:Scleroderma, Localized / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D012867:Skin / Q000293:injuries*
keywords: Dermatology Life Quality Index; Morphea in Adults and Children cohort; localized scleroderma; modified Rodnan Skin Score; morphea; skin trauma