Conventional ultrasound combined with shear wave elastography for assessing disease activity in pediatric localized...

Pediatric localized scleroderma is a chronic connective tissue disorder that currently lacks reliable, objective biomarkers for assessing disease activity.

To analyze conventional ultrasound and shear wave elastography (SWE) features of pediatric localized scleroderma and to evaluate their correlation with disease activity.

Between January 2021 and September 2025, 37 patients ≤ 17 years with confirmed localized scleroderma were prospectively enrolled. Lesions were assessed using the Localized Scleroderma Skin Activity Index (LoSAI), the Skin Damage Index (LoSDI), and total scores; disease activity was defined as a LoSAI score > 0. Lesion parameters (thickness, echogenicity, vascularity, and skin stiffness) were measured and compared with contralateral healthy skin. Correlations of these parameters with LoSAI, LoSDI, and total scores were analyzed.

Forty-five active lesions from 37 patients (mean age 8.0 years; range, 6.0-11.0 years; 20 girls) were analyzed. Compared with healthy skin, active lesions exhibited significantly thinner subcutaneous tissue (0.8 mm vs. 1.5 mm; P < 0.001) and reduced combined dermis/subcutaneous tissue thickness (2.0 mm vs. 2.8 mm; P < 0.001), along with significantly higher skin stiffness (73.1 kPa vs. 26.8 kPa; P < 0.001), increased echogenicity (P < 0.001), and greater vascularity (P = 0.002). Skin stiffness in active lesions was positively correlated with both the LoSAI score (r = 0.702, P < 0.001) and the total score (r = 0.610, P < 0.001).

The combination of conventional ultrasound and SWE provides a feasible and potentially clinically valuable tool for assessing disease activity in pediatric patients with localized scleroderma.