17 year old girl with generalized morphea that began over 13 years earlier. She has lesions on her back, abdomen, arms, and leg. Most lesions show dyspigmentation and mild tissue loss, but her back lesions have increased warmth. Ultrasound of a back lesion shows thinning of the dermis and hypodermis, and an increase in lesion dermal echogenicity (dermis echogenicity = 1). There are highly echogenic horizontal bands in the hypodermis layer of both the normal and lesion hypodermis layers. The echogenicity of these bands is increased in the lesion, as is the base level of hypodermal echogenicity (hypodermis echogenicity = 2). The lesion muscle shows a patchy increase in echogenicity compared to the normal muscle (deep tissue echogenicity = 1). Arrowheads indicate boundaries of dermis, while arrows indicate boundaries of hypodermis and muscle.