Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions.
OBJECTIVE
To evaluate in SSc, the frequency of digital lesions and the morphology, characteristics, natural course and time to healing of 1614 digital ulcers (DUs).


METHODS
One hundred SSc patients were followed up for 4 years. In the first step, the digital lesions were observed and classified at the time of presentation [digital pitting scar (DPS); DU; calcinosis; gangrene]. In the second step, DUs were divided into subsets according to their origin and main features. In the third step, the time to healing was recorded for each DU and the influence of DU main characteristics on time to healing was also evaluated.


RESULTS
In the first step, 1614 digital lesions were observed: DPS, 712 (44.1%) lesions; DU, 785 (48.6%); calcinosis, 110 (6.8%); and gangrene, 7 (0.8%). In the second step, DUs were subsetted as follows: DU developed on DPS (8.8%), pure DU; DU developed on calcinosis (60%); DU derived from gangrene. In the third step, the mean time to healing was 25.6 (15.6) days in DPS, 76.2 (64) days in pure DU, 93.6 (59.2) days in calcinosis ulcers and 281.1 (263.3) in gangrene.


CONCLUSIONS
In SSc, digital lesions are represented by DPS, DU, calcinosis and gangrene, and provide an evidence-based DU subsetting according to their origin and main characteristics. Subsetting may be helpful for a precise DU evaluation and staging, and in randomized controlled trials for a precise identification of those DUs that are to be included in therapeutic studies.
Amanzi
Laura
L
Department of Biomedicine, Division of Rheumatology, AOUC, Denothe Centre, Firenze, Italy.
Braschi
Francesca
F
Fiori
Ginevra
G
Galluccio
Felice
F
Miniati
Irene
I
Guiducci
Serena
S
Conforti
Maria-Letizia
ML
Kaloudi
Olga
O
Nacci
Francesca
F
Sacu
Oana
O
Candelieri
Antonio
A
Pignone
Alberto
A
Rasero
Laura
L
Conforti
Domenico
D
Matucci-Cerinic
Marco
M
D002114:Calcinosis / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D005121:Extremities; D005260:Female; D005734:Gangrene / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D012595:Scleroderma, Systemic / Q000145:classification / Q000150:complications* / Q000473:pathology; D012720:Severity of Illness Index; D012883:Skin Ulcer / Q000209:etiology* / Q000473:pathology; D013223:Statistics as Topic; D013997:Time Factors