Recognizing and managing linear morphea in a pediatric patient with skin of color

Linear morphea is the most prevalent subtype of morphea in pediatric patients and poses a significant clinical concern because of its potential to involve deeper tissues, including muscle, fascia, and bone. If not identified and treated promptly, this can result in long-term complications such as joint contractures, limb length discrepancies, and functional impairment. Diagnosing and managing morphea in children with skin of color presents unique challenges, as hallmark inflammatory signs like erythema may be less visible or absent altogether, leading to delays in diagnosis and difficulties in monitoring disease activity. In darker skin tones, active lesions may instead present as hyperpigmented or hypopigmented patches, which can mimic other common pediatric dermatoses. These diagnostic limitations underscore the need for heightened clinical suspicion and tailored diagnostic strategies in this population. While consensus-based treatment algorithms exist for pediatric morphea, these guidelines are largely derived from studies in lighter skin types and do not address diagnostic and monitoring challenges unique to patients with skin of color. Additional research is needed to develop inclusive guidelines that address these gaps and improve long-term disease control. Herein, we present the case of linear morphea in a 5-year-old African American child, highlighting the diagnostic, therapeutic, and monitoring challenges specific to pediatric patients with skin of color.