Figure 5

15 year old girl with over an 8-year history of localized scleroderma. She initially presented with linear scleroderma of one hand that extended up her arm. There has been recent extension of this lesion to her upper back, and circumscribed morphea lesions have developed on her chest and thigh. Ultrasound image shown is of her upper arm, which had chronic atrophy and hyperpigmentation, but also mild erythema. There is increased vascularity in the lesion muscle, with over 10 discrete color Doppler signals in this layer versus none in the normal muscle. The deep tissue vascularity is scored as 2 because there are over two-fold more color Doppler signals in the lesion compared to normal; the vascularity is not scored as 3 because all of the lesion color Doppler signals are of a similar small size. The normal hypodermis has over two-fold more color Doppler signals than the lesion in this image, giving a lesion hypodermal vascularity score of -1. D = dermis, H = hypodermis, and M = muscle. Arrowheads indicate boundaries of dermis, while arrows indicate boundaries of hypodermis.