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

J Am Acad Dermatol. 2009 Mar;60(3):426-35. doi: 10.1016/j.jaad.2008.11.025.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Male
  • Metabolic Syndrome / epidemiology
  • Middle Aged
  • Nails / blood supply
  • Neovascularization, Physiologic
  • Predictive Value of Tests
  • Risk Factors
  • Scleroderma, Systemic / epidemiology*
  • Scleroderma, Systemic / immunology*
  • Scleroderma, Systemic / therapy
  • Skin Ulcer / epidemiology*
  • Skin Ulcer / immunology*
  • Skin Ulcer / therapy
  • Smoking / epidemiology
  • Wound Healing*


  • Biomarkers