Our study confirms increased concentrations of CXCL9 and CXCL10 in morphea serum and correlation of CXCL9 to mLoSSI, a validated measure for disease activity. In addition to that, we also observe correlation between CXCL10 and mLoSSI. Our analysis demonstrates no relations between the presence of disease damage, captured by the Localized Scleroderma Damage Index score, and both CXCL9 and CXCL10. Torok et al. (2015) reported a similar correlation (r s ¼ 0.34) between CXCL10 and mLoSSI and no significant correlation between CXCL10 and Localized Scleroderma Damage Index scores in cohort of 69 pediatric morphea patients (Torok et al., 2015). The strong correlation between CXCL9 and CXCL10 serum concentrations combined with the similar trends in correlations between clinical measures and both chemokines, suggest equal biomarker capabilities for both CXCL9 and CXCL10.Furthermore, we demonstrate increased CXCL9 and CXCL10 gene expression at both the inflammatory border and the sclerotic center of affected morphea tissue, with normal gene expression at unaffected tissue of morphea patients. A strong correlation between CD68 and CXCL9 and CXCL10 gene expression, together with the lack of an association between circulating monocytes, and these chemokines not only suggests a relationship between the presence of local macrophages and CXCL9/CXCL10 production, it also underscores that morphea is a disease confined to the skin where inflammatory markers are measured in the circulation as the result from "leakage" from the inflammatory sites.In conclusion, we confirm the potential of CXCL9 as biomarker for disease activity in morphea. Interestingly, CXCL10 serum concentrations showed similar biomarker capabilities. Lastly, increased CXCL9 and CXCL10 gene expression in morphea skin, and absence of increased gene expression in monocytes, supports the hypothesis, postulated by O'Brien et al. (2017), that morphea may result from skin-directed immune dysregulation rather than the systemic presence of inflammation on contrast to that observed in systemic scleroderma.