Vascular Patterning in Morphea Mimicking a Capillary Malformation: Case Report and Review of the Literature

ABSTRACT Early, inflammatory morphea can rarely mimic an acquired capillary malformation (CM), and emerging evidence suggests that endothelial injury may precede fibrosis in morphea, with vascular abnormalities driving immune recruitment and fibroblast activation. We present a pediatric case of inflammatory linear morphea initially misdiagnosed as an acquired CM. Dynamic optical coherence tomography (OCT) demonstrated a dense, superficial vascular network, resembling that seen in genetically confirmed capillary malformations. This case highlights the key clinical and morphologic features of morphea, with clinical pearls to differentiate from acquired CMs. Early recognition of this clinical mimic is critical to prevent irreversible atrophy and fibrosis.