Color Doppler Ultrasound Assessment of Subclinical Activity With Scoring of Morphea

Abstract

Background: Detection of activity in morphea is paramount for adequately managing the disease. Subclinical ultrasoundinvolvement on inactive lesions or healthy skin areas adjacent to morphea has not been described to date.Objectives: The study aimed to detect morphea’s subclinical activity by Color Doppler ultrasound not identified with theclinical scorings.Materials & methods: This cross-sectional retrospective study was done from January 2014 to July 2019 in patients witha clinicopathological diagnosis of morphea. The modified Localized Scleroderma Skin Severity Index (mLoSSI) and TheUltrasound Morphea Activity Score (US-MAS) were used to correlate clinical and subclinical activity.Results: A total of 36 patients met the inclusion criteria. 54% of cases presented subclinical activity in areas adjacent to theclinically active lesion, 23% in nonadjacent regions, and 23% demonstrated activity at a clinically inactive lesion site.100% of patients with morphea “en coup de sabre” involving the frontal region of the face concomitantly presented bothsubclinical activities of morphea on the frontal facial region and the scalp following the same axis.A positive relationship was observed between the degree of clinical activity measured by mLoSSI and US-MAS scoring.The main limitations of our study were the low number of patients and the inability to detect alterations < 0.1 mm.Conclusions: Subclinical activity is frequent in morphea, can extend beyond the lesional areas, including apparently noninvolved adjacent and distant corporal regions, and can be detected by color Doppler ultrasound.