Original article
Activity assessment in morphea using color Doppler ultrasound

https://doi.org/10.1016/j.jaad.2010.08.027Get rights and content

Background

Morphea (circumcripted cutaneous scleroderma) can be difficult to assess for lesion activity. Because variable-frequency ultrasound with color Doppler provides details of skin morphology and function, it may help in the categorization of morphea.

Objective

We sought to evaluate color Doppler ultrasound as a probing tool for assessing activity in morphea lesions.

Methods

Consecutive patients with cutaneous morphea referred by dermatologists were studied with color Doppler ultrasound, and the assessment of lesion activity was compared with histologic findings. Normal skin controls were obtained by performing ultrasound scans of healthy subjects or of unaffected areas of the patients themselves. Measurements included cutaneous layer thickness, relative echogenicity, and blood flow with peak systolic velocity. Ultrasound sensitivity and specificity were determined for each phase of morphea activity and the results correlated with histology.

Results

Fifty-one patients had a total of 104 morphea lesions. Of the lesions, 20% were active, 22% were atrophic, and 58% were inactive. Five of the patients had the Parry-Romberg syndrome with ipsilateral parotid gland inflammatory involvement, and one had an asymptomatic but sonographically active morphea lesion. Sensitivity and specificity for ultrasound diagnosis were 100% and 98.8%, respectively. The most accurate sonographic signs of lesion activity were increased subcutaneous tissue echogenicity and increased cutaneous blood flow (sensitivity and specificity 100% and 100% for each one).

Limitations

Ultrasound cannot define lesions less than 0.1-mm deep.

Conclusions

The morphologic and functional data obtained noninvasively and in real time with color Doppler ultrasound provide new insight into the pathogenesis of morphea. The technique represents a useful counterpart to histologic examination for the assessment of lesion activity.

Section snippets

Methods

The study included all patients with primary cutaneous morphea (not associated with collagen vascular diseases) referred by dermatologists for a color Doppler ultrasound examination between March 2001 and December 2009. The diagnosis had been confirmed in every case by subsequent histologic examination of a skin biopsy specimen (not available at the time of the imaging study). To ensure that the tests reflected similar lesion activity, cases were included only when histology specimens had been

Results

Of 10,604 dermatologist-referred patients, 51 with morphea lesions met the requisites for inclusion in the study (37 female and 14 male; mean age 28 years; range 4-68 years). Twelve of the patients with morphea (24% of the total) were in the pediatric group (<15 years old). A single lesion was present in 36 patients and 15 had multiple lesions, with a cumulative total of 104 morphea lesions analyzed. Diagnostic concordance between sonographic and histologic diagnosis was found in all but one

Discussion

This work, which comprises one of the largest series of histologically confirmed morphea lesions, demonstrates the usefulness of sonographic monitoring for the assessment of disease activity. Importantly, we found activity to be a pleomorphic variable because it could selectively involve only one of multiple lesions, or even focal areas in a single lesion. Also remarkable is the previously unreported involvement of the parotid gland of patients with PRS, on the same side of the facial

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  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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