Skin ulcers in systemic sclerosis – etiopathogenesis, prophylaxis and treatment

Skin ulcers are a frequent complication of systemic sclerosis. Digital ulcers are present in almost 30% of patients with limited systemic sclerosis and in 60% of patients with diffuse systemic sclerosis. Digital ulcers usually develop on the fingertips, over the extensor surface of the joints and from pre-existing calcinosis. Among the mechanisms considered to be responsible for the development of ulcers at the digital tips, one is related to the microvasculopathy and an increased production of vasoconstrictors; the other is related to the existence of thrombosis. Severe skin sclerosis is more frequent in patients with ulcers at the extensor surface of joints. Lower limb ulcers, although not common, have a multifactorial pathogenesis and are therefore the most difficult to manage. The management of systemic sclerosis ulcers involves screening for complications, promoting healing and preventing recurrences. The article discusses non-pharmacological, pharmacological and surgical treatment.