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 patie...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2009-03, Vol.60 (3), p.426-435
Main Authors: Alivernini, Stefano, MD, De Santis, Maria, MD, Tolusso, Barbara, BS, Mannocci, Alice, MS, Bosello, Silvia Laura, MD, Peluso, Giusy, MD, Pinnelli, Michela, MD, D'Antona, Graziella, MD, LaTorre, Giuseppe, MD, Ferraccioli, Gianfranco, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Biomarkers - blood
Comorbidity
Dermatology
Female
Follow-Up Studies
Humans
Logistic Models
Male
Medical sciences
Metabolic Syndrome - epidemiology
Middle Aged
Nails - blood supply
Neovascularization, Physiologic
Predictive Value of Tests
Risk Factors
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Scleroderma, Systemic - epidemiology
Scleroderma, Systemic - immunology
Scleroderma, Systemic - therapy
Skin Ulcer - epidemiology
Skin Ulcer - immunology
Skin Ulcer - therapy
Smoking - epidemiology
Wound Healing
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Summary: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 6 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.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2008.11.025