The Performance of Current Morphea Subtype Classifications JAMA Dermatology

TAKE-HOME MESSAGE

• With numerous classification systems for morphea subtypes that include unique subtypes, confusion and impaired classification of disease type arise in both clinical evaluation and research. The authors of this study aimed to compare the accuracy of various classification systems in identifying subtypes among 944 patients. The Padua criteria classified 95% of patients correctly, whereas the Peterson criteria and the European Dermatology Forum classification correctly classified 56% and 52% of patients, respectively.

• Although there are ambiguous features in the classification schemes for morphea that need to be addressed, the Padua criteria outperformed the other classification schemes, thereby supporting their use in clinical and research applications until further refinement of the criteria can be accomplished in a consensus-based multidisciplinary approach.

– Caroline K. Crabtree, MD

Abstract

IMPORTANCE

Numerous classification systems for morphea subtypes exist, but none have been systematically evaluated for their ability to categorize patients with morphea into demographically and clinically coherent groups. Although some subtypes, such as linear morphea, are present across all the classification schemes, others list unique subtypes. This creates confusion among investigators and practitioners and impairs accurate categorization of patients for study and clinical evaluation.

OBJECTIVE

To evaluate how frequently the commonly used morphea classification systems categorize patients with morphea into clinically relevant subtypes using cross-sectional analysis of 2 large patient cohorts.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study comprised 944 adults and children from 2 prospective cohorts-the Morphea in Adults and Children at the University of Texas Southwestern Medical Center (Dallas, Texas), which enrolled participants from July 20, 2007, to September 21, 2018, and the National Registry for Childhood-Onset Scleroderma at the University of Pittsburgh (Pittsburgh, Pennsylvania), which enrolled participants from October 23, 2002, to November 13, 2018.

MAIN OUTCOMES AND MEASURES

Patient demographic characteristics, morphea subtype, quality-of-life measures, disease activity, and damage as measured by Localized Scleroderma Cutaneous Assessment Tool scores during initial visits.

RESULTS

A total of 944 participants (444 patients with adult-onset morphea and 500 patients with pediatric-onset morphea; 741 female participants [78%]; median age at onset, 16 years [interquartile range, 8-44 years]) were included in this study. Most participants were White (723 [77%]) and had the linear (474 [50%]) or generalized subtype of morphea (244 [26%]). With the use of the previously published Padua criteria, most patients were classified to have linear morphea (474 [50%]), followed by generalized morphea (244 [26%]), plaque morphea (141 [15%]), mixed morphea (38 [4%]), and pansclerotic morphea (3 [0.3%]). Overall, the Padua criteria successfully classified 900 patients (95%) in comparison with the Peterson criteria (533 [56%]) and the European Dermatology Forum classification (487 [52%]).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of morphea subtype classification systems, the Padua criteria performed best in classifying patients into subgroups with cohesive demographic and clinical features, supporting its widespread use. However, they have ambiguities that might lead to misclassification, particularly in terms of generalized and pansclerotic morphea and descriptors such as morphea profunda. Consensus-based approaches are needed to address these ambiguities and develop a unified classification scheme.

JAMA Dermatology

An Evaluation of the Performance of Current Morphea Subtype Classifications

JAMA Dermatol 2021 Feb 17;[EPub Ahead of Print], S Prasad, JL Zhu, K Schollaert-Fitch, KS Torok, HT Jacobe 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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