title: Skin ulcers in systemic sclerosis: determinants of presence and predictive factors of healing.
abstract: 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.
authors.affiliation: Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Alivernini
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.forename: Barbara
authors.initials: B
authors.lastname: Tolusso
authors.forename: Alice
authors.initials: A
authors.lastname: Mannocci
authors.forename: Silvia Laura
authors.initials: SL
authors.lastname: Bosello
authors.forename: Giusy
authors.initials: G
authors.lastname: Peluso
authors.forename: Michela
authors.initials: M
authors.lastname: Pinnelli
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Antona
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Giuseppe
authors.initials: G
authors.lastname: LaTorre
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: 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
chemical_list: D015415:Biomarkers