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Toward a Better Understanding of the Spectrum of Morphea

Virginie Lutz, MD; Camille Francès, MD, PhD; Didier Bessis, MD; Anne Cosnes, MD; Nicolas Kluger, MD; Julien Godet, PhD; Erik Sauleau, PhD; Dan Lipsker, MD, PhD

Arch Dermatol. 2012;148(1):24-28. doi:10.1001/archdermatol.2011.305

Objective  To compare the frequency of genital lichen sclerosus (LS) in patients with morphea with that of control patients.

Design  A prospective multicenter study.

Setting  Four French academic dermatology departments: Strasbourg, Montpellier, Tenon Hospital Paris, and Henri Mondor Hospital Créteil.

Patients  Patients were recruited from November 1, 2008, through June 30, 2010. Seventy-six patients with morphea and 101 age- and sex-matched controls, who underwent complete clinical examination, were enrolled.

Interventions  A complete clinical examination and, if deemed necessary, a cutaneous biopsy.

Main Outcome Measure  The frequency of genital LS.

Results  There were 58 women and 18 men (a 3:1 ratio) with a median age of 59 years. Mean (range) age at diagnosis was 54 (13-87) years. Forty-nine patients had plaque morphea, 9 had generalized morphea, and 18 had linear morphea. Three patients (3%) in the control group and 29 patients (38%) with morphea had LS (odds ratio, 19.8; 95% CI, 5.7-106.9; P < .001). Twenty-two patients with plaque morphea (45%) and only 1 patient with linear morphea (6%) had associated genital LS.

Conclusions  Genital LS is significantly more frequent in patients with morphea than in unaffected individuals. Forty-five percent of patients with plaque morphea have associated LS. Complete clinical examination, including careful inspection of genital mucosa, should therefore be mandatory in patients with morphea because genital LS bears a risk of evolution into squamous cell carcinoma and thus needs treatment with topical corticosteroids.

Author Affiliations: Faculté de Médecine, Clinique Dermatologique (Drs Lutz and Lipsker), Study Group of Systemic Diseases in Dermatology (EMSED: Étude des Maladies Systémiques en Dermatologie) (Drs Francès, Bessis, Cosnes, and Lipsker), and Département de Santé Publique, Secteur Biostatistiques et Méthodologies (Drs Godet and Sauleau), Université de Strasbourg, Centre Hospitalier Universitaire de Strasbourg, Strasbourg; Service de Dermatologie, Hôpital Tenon, Université Pierre et Marie Curie-Paris 6, Paris (Dr Francès); Université Montpellier I, Service de Dermatologie, Centre Hospitalier Universitaire de Montpellier, Montpellier (Dr Bessis); and Service de Dermatologie, Hôpital Henri Mondor, Créteil (Dr Cosnes), France; and Departments of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergy Hospital, Helsinki University Central Hospital, Finland (Dr Kluger).

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