14 year old girl with linear scleroderma affecting her left arm; portion shown is from her upper arm. She has chronic atrophy from long standing disease (11 years), with persistent signs of disease activity including erythema and pruritis. Ultrasound shows varying patterns of echogenicity differences in the lesion, with no difference found in the dermis (dermis echogenicity = 0), mildly increased echogenicity in the hypodermis in a patchy pattern (hypodermis echogenicity = 1), and decreased echogenicity in the muscle (deep tissue echogenicity = -1). Ultrasound allows facile measurement of tissue thickness. Cursors were placed at tissue boundaries, using the highest point of the humeral bone as a landmark for the measurements. The lesion dermis is thinner than the normal dermis (measurement 2 (0.14 cm) vs 1 (0.21 cm), respectively; dermis tissue thickness score 1). The lesion hypodermis is mildly thicker than the normal hypodermis (measurement 4 (0.82 cm) vs 3 (0.75 cm), respectively; hypodermis tissue thickness score -1). The lesion muscle is thinner than the normal muscle (measurement 6 (0.93 cm) vs 5 (1.38 cm), respectively; deep tissue tissue thickness score 2). B = bone, D = dermis, H = hypodermis, and M = muscle. Arrowheads indicate boundaries of dermis, while arrows indicate boundaries of hypodermis and muscle. Large tick marks on x and y axis = 1 cm.