Morphea (localized scleroderma) is a connective tissue disorder characterized by dermal stiffness, thickening, erythema, and pigmentation abnormalities, often varying with the degree of inflammation and fibrosis.¹ Precise lesion activity is crucial for tailoring optimal treatment plans. Traditional diagnostic methods like skin biopsy are invasive and may not effectively capture the dynamic progression of the disease.² Noninvasive imaging techniques, including ultrasound (US) and shear wave elastography (SWE), present promising alternatives for diagnosis and monitoring by assessing vascular changes and skin stiffness.^1,3 This case-control study evaluates the effectiveness of US and SWE in distinguishing between active and inactive morphea lesions, aiming to improve the accuracy of morphea management.