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 ultrasound involvement 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 the clinical scorings. Materials & methods This cross-sectional retrospective study was done from January 2014 to July 2019 in patients with a clinicopathological diagnosis of morphea. The modified Localized Scleroderma Skin Severity Index (mLoSSI) and The Ultrasound 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 the clinically 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 both subclinical 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.

Ultrasound Utility in the Management of Morphea: A Comprehensive Review

“…Not only lesional activity could be detected, but Parra-Cares et al , 2023 demonstrated that subclinical activity in morphea could be detected by color Doppler ultrasonography (CDU) utilizing the US-MAS grading criteria. [ 9 ] Subclinical Doppler activity was detected in 36.1% of the lesions in the study. The subclinical activity detected was directly adjacent to the clinically active lesion in 54% of the cases, 23% in nonadjacent regions, and 23% at the site of a clinically inactive lesion.…”

High‐frequency ultrasound evaluation of morphea: Retrospective analytical study

“…24 This technology offers superior axial spatial resolution compared to other methods such as MRI. 25 MRI still remains a gold standard for the evaluation of subcutaneous tissue, especially in generalized and deep morphea. 16 , 26 , 27 Clarius L20 HD3 Ultra‐High Frequency Linear Scanner is the only handheld ultrasound with ultra‐high frequency of 20 MHz and a depth of up to 4 mm.…”

“…The 22 MHz DUB skin scanner utilized in our study is widely recognized as a noninvasive method for skin analysis, providing continuous and rapid high‐resolution ultrasonography 24 . This technology offers superior axial spatial resolution compared to other methods such as MRI 25 . MRI still remains a gold standard for the evaluation of subcutaneous tissue, especially in generalized and deep morphea 26,27,16 .…”

Update on Ultrasound Diagnostic Criteria and New Ultrasound Severity and Activity Scorings of Hidradenitis Suppurativa

“…This approach is similar to the modified activity scoring of morphea, the cutaneous form of scleroderma, which is another cutaneous autoimmune disease that benefits from the ultrasound detection of subclinical activity under standardized anatomical regions and subregions. 24,25 Moreover, the use of power Doppler has been reported as a validated biomarker of activity in HS. 26 Hence, detecting and characterizing the lesional blood flow is an essential tool for assessing the inflammatory activity degree.…”