Morphea

Morphea is a self-limited or chronically relapsing connective tissue disorder characterized by excessive collagen deposition leading to thickening of the dermis and/or subcutaneous tissues. Individual lesions of morphea typically begin with an erythematous, edematous, inflammatory phase, which is followed by the development of central sclerosis presenting as thickening and ivory white discoloration; an erythematous-to-violaceous border is typically visible in active lesions. Over months or years, sclerotic lesions soften and become atrophic with hypo- or hyperpigmentation. The most peculiar dermatoscopic feature of sclerotic/active morphea lesions consists of whitish fibrotic beams, which are frequently crossed by linear branching vessels. Of note, such findings are also visible in clinically non-sclerotic patches, thereby facilitating the recognition of this dermatosis even in early phases. Pigment network-like structures are also often evident.