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 C 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. (J Am Acad Dermatol 2009;60:426-35.)
Alivernini, S., De Santis, M., Tolusso, B., Mannocci, A., Bosello, S. L., Peluso, G., Pinnelli, M., D'Antona, G., La Torre, G., Ferraccioli, G., Skin ulcers in systemic sclerosis: determinants of presence and predictive factors of healing, <<JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY>>, 2009; 60 (3): 426-435. [doi:10.1016/j.jaad.2008.11.025] [https://hdl.handle.net/10807/237898]
Skin ulcers in systemic sclerosis: determinants of presence and predictive factors of healing
Alivernini, Stefano;Tolusso, Barbara;Bosello, Silvia Laura;Peluso, Giusy;La Torre, Giuseppe;Ferraccioli, Gianfranco
2009
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 C 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. (J Am Acad Dermatol 2009;60:426-35.)
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