TY - JOUR
T1 - Skin mapping for the classification of generalized morphea
AU - Teske, Noelle
AU - Welser, Joseph
AU - Jacobe, Heidi
N1 - Funding Information:
Research for this manuscript was supported in part by National Institutes of Health (NIH) grant no. K23AR056303-5 . This work was conducted with support from the University of Texas-Science and Technology Acquisition and Retention Program (UT-STAR), NIH / National Center for Research Resources (NCRR) grant number 4UL1TR001105-04 / National Center for Advancing Translational Sciences grant no. UL1TR000451 . 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, NCRR, or NIH.
Publisher Copyright:
© 2016 American Academy of Dermatology, Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Background: Generalized morphea lacks cohesive clinical features, limiting its clinical and investigative utility. Objective: We sought to use computerized lesion mapping to objectively subtype morphea. Methods: We conducted a 2-part cross-sectional study. In part 1, we created a discovery cohort of patients with generalized morphea of whom lesion maps were created to characterize subsets. Clinical and demographic features were compared between proposed subsets to determine if they identified clinically relevant differences. In part 2, we created a validation cohort to determine if proposed criteria were applicable to different individuals. Results: A total of 123 patients with generalized morphea were included. Mapping produced 2 distribution patterns that encompassed the majority in both cohorts: isomorphic (areas of skin friction) and symmetric (symmetrically distributed on trunk/extremities). In the discovery cohort, the isomorphic subset was older (55.6 ± 12.7 vs 42.2 ± 20.1 years, P <.001), all female (30/30 vs 38/43, P =.05), and more often had lichen sclerosus changes (12/43 vs 8/43, P =.02); involvement of the reticular dermis, subcutaneous fat, and/or fascia was more common in symmetric (10/43 vs 1/30) (P =.02). These features persisted in the validation cohort. Limitations: Single cohort was a limitation. Conclusions: Symmetric and isomorphic subsets possess distinctive demographic and clinical features, suggesting they more accurately define the phenotype of generalized morphea. Consideration should be given to revising classification.
AB - Background: Generalized morphea lacks cohesive clinical features, limiting its clinical and investigative utility. Objective: We sought to use computerized lesion mapping to objectively subtype morphea. Methods: We conducted a 2-part cross-sectional study. In part 1, we created a discovery cohort of patients with generalized morphea of whom lesion maps were created to characterize subsets. Clinical and demographic features were compared between proposed subsets to determine if they identified clinically relevant differences. In part 2, we created a validation cohort to determine if proposed criteria were applicable to different individuals. Results: A total of 123 patients with generalized morphea were included. Mapping produced 2 distribution patterns that encompassed the majority in both cohorts: isomorphic (areas of skin friction) and symmetric (symmetrically distributed on trunk/extremities). In the discovery cohort, the isomorphic subset was older (55.6 ± 12.7 vs 42.2 ± 20.1 years, P <.001), all female (30/30 vs 38/43, P =.05), and more often had lichen sclerosus changes (12/43 vs 8/43, P =.02); involvement of the reticular dermis, subcutaneous fat, and/or fascia was more common in symmetric (10/43 vs 1/30) (P =.02). These features persisted in the validation cohort. Limitations: Single cohort was a limitation. Conclusions: Symmetric and isomorphic subsets possess distinctive demographic and clinical features, suggesting they more accurately define the phenotype of generalized morphea. Consideration should be given to revising classification.
KW - clinical research
KW - cohort study
KW - cross-sectional study
KW - disease registry
KW - localized scleroderma
KW - morphea
KW - skin mapping
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U2 - 10.1016/j.jaad.2016.08.052
DO - 10.1016/j.jaad.2016.08.052
M3 - Article
C2 - 29332706
AN - SCOPUS:85044659978
SN - 0190-9622
VL - 78
SP - 351
EP - 357
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 2
ER -