Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, University of Tennessee Health Science Center at Memphis, Memphis, Tennessee.
J Am Acad Dermatol. 2018 Feb;78(2):351-357. doi: 10.1016/j.jaad.2016.08.052.
Generalized morphea lacks cohesive clinical features, limiting its clinical and investigative utility.
We sought to use computerized lesion mapping to objectively subtype morphea.
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.
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.
Single cohort was a limitation.
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.
泛发性硬斑病缺乏有凝聚力的临床特征，限制了其临床和研究应用。
我们试图使用计算机化病变图来客观地下硬斑病亚型分类。
我们进行了一项两部分的横断面研究。在第 1 部分中，我们创建了一个患有泛发性硬斑病的患者发现队列，为其创建病变图以描述亚组。比较提出的亚组之间的临床和人口统计学特征，以确定它们是否确定了具有临床意义的差异。在第 2 部分中，我们创建了一个验证队列，以确定提出的标准是否适用于不同的个体。
共有 123 名患有泛发性硬斑病的患者被纳入研究。绘图产生了两种涵盖两个队列中大多数患者的分布模式：同形（皮肤摩擦区域）和对称（躯干/四肢对称分布）。在发现队列中，同形组年龄更大（55.6 ± 12.7 岁比 42.2 ± 20.1 岁，P < 0.001），均为女性（30/30 比 38/43，P = 0.05），且更常发生硬化性苔藓样改变（12/43 比 8/43，P = 0.02）；对称组中真皮网状层、皮下脂肪和/或筋膜受累更为常见（10/43 比 1/30）（P = 0.02）。这些特征在验证队列中仍然存在。
单队列是一个局限性。
对称和同形亚组具有独特的人口统计学和临床特征，这表明它们更准确地定义了泛发性硬斑病的表型。应考虑修订分类。
