The Value of Ultrasonography in the Diagnosis and Monitoring of Localized Morphea — Case Report

Anca Chiriac 1 , 2 , Piotr Brzezinski 3 , Anca E. Chiriac 4 , Marius Florin Coroș 5 , Cosmin Moldovan 6 , Cristian Podoleanu 7 , and Simona Stolnicu 8
  • 1 Department of Dermatology, Nicolina Medical Center, Iași, Romania
  • 2 Department of Dermato-Physiology, Apollonia University, Iași, Romania
  • 3 Department of Dermatology, 6 Military Support Unit, Poland
  • 4 “Gr. T. Popa” University of Medicine and Pharmacy, Iași, Romania
  • 5 Department of Surgery, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
  • 6 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
  • 7 Department of Internal Medicine IV, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
  • 8 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania


Introduction: The aim of this presentation is to highlight the usefulness of high-frequency ultrasound (18 MHz) in localized morphea for: identification of the lesion, guided skin biopsy, quantification of skin thickness, evaluating the severity by measuring total echogenicity.

Case presentation: A 62-year-old Caucasian woman was referred to the Dermatology Department for a well-circumscribed indurate plaque localized on the right side of the abdominal wall and thigh. On clinical examination, a large well-delimited, indurate plaque, silvery in the center and surrounded by a purplish-red halo (lilac ring) was noticed on the right side of the abdomen and thigh. An ultrasound-guided punch biopsy was carried out and the microscopic examination of the biopsy revealed moderate interstitial inflammatory infiltrate together with abundant collagen bundles in the dermis and subcutis and a diagnosis of localized morphea (scleroderma) was established. Ultrasonography was performed and skin thickness was measured using high-frequency US (18 MHz) and was found to be 3.1 mm to 3.9 mm.

Conclusion: high frequency ultrasound is an inexpensive, easy to perform, noninvasive method, replacing surgical biopsy and offering a valuable quantification of skin fibrosis.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Wortsman X. Ultrasound in dermatology: why, how, and when? Semin Ultrasound CT MR. 2013;34(3):177-195.

  • 2. Wortsman X, Wortsman J. Ultrasound accuracy in the diagnosis of skin and soft-tissue lesions. AJR Am J Roentgenol. 2015;204(2):W220.

  • 3. Li SC, Liebling MS, Haines KA, Weiss JE, Prann A. Initial evaluation of an ultrasound measure for assessing the activity of skin lesions in juvenile localized scleroderma. Arthritis Care Res (Hoboken). 2011;63(5):735-742.

  • 4. Wortsman X, Wortsman J. Clinical usefulness of variable frequency ultrasound in localized lesions of the skin. J Am Acad Dermatol. 2010;62(2):247-256.

  • 5. Wortsman X, Vergara P, Castro A, et al. Ultrasound as predictor of histologic subtypes linked to recurrence in basal cell carcinoma of the skin. J Eur Acad Dermatol Venereol. 2015;29(4):702-707.

  • 6. Porta F, Kaloudi O, Garzitto A, et al. High frequency ultrasound can detect improvement of lesions in juvenile localized scleroderma. Mod Rheumatol. 2014;24(5):869-873.

  • 7. Wortsman X. Common applications of dermatologic sonography. J Ultrasound Med. 2012;31(1):97-111.


Journal + Issues