Skin ulcers in systemic sclerosis: determinants of presence and predictive factors of healing

Background Skin ulcers are common vascular complications of systemic sclerosis (SSc).Objective: The aim of the study was to identify clinical, biologic, and imaging parameters that constitute risk factors for the occurrence and persistence of skin ulcers.Methods: One hundred thirty Italian SSc patients were examined at entry and after 20 months of follow-up.Results: The diffuse SSc phenotype with avascular areas on capillaroscopy, thrombophilia, and systemic inflammation as defined by interleukin C plasma levels, represented the major risk factors for ulcer development. Infection was associated with a risk of poor or no healing, and cardiopulmonary involvement was a major comorbid factor in patients with ulcers. The presence of infection and avascular areas represented the main determinants for ulcer healing.Limitations: Our data should be confirmed with a longer follow-up period since skin ulcers represent a frequent vascular complication in scleroderma patients.Conclusion: Aggressive therapies aiming at improving angiogenesis and controlling infection and the course of the disease appear to be crucial to obtain ulcer healing. (J Am Acad Dermatol 2009;60:426-35.)