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 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.


CONCLUSIONS
Our data should be confirmed with a longer follow-up period since skin ulcers represent a frequent vascular complication in scleroderma patients.


CONCLUSIONS
Aggressive therapies aiming at improving angiogenesis and controlling infection and the course of the disease appear to be crucial to obtain ulcer healing.
Alivernini
Stefano
S
Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
De Santis
Maria
M
Tolusso
Barbara
B
Mannocci
Alice
A
Bosello
Silvia Laura
SL
Peluso
Giusy
G
Pinnelli
Michela
M
D'Antona
Graziella
G
La Torre
Giuseppe
G
LaTorre
Giuseppe
G
Ferraccioli
Gianfranco
G
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009262:Nails / Q000098:blood supply; D018919:Neovascularization, Physiologic; D011237:Predictive Value of Tests; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000453:epidemiology* / Q000276:immunology* / Q000628:therapy; D012883:Skin Ulcer / Q000453:epidemiology* / Q000276:immunology* / Q000628:therapy; D012907:Smoking / Q000453:epidemiology; D014945:Wound Healing
D015415:Biomarkers