Background/Purpose:

Cutaneous ulcers reppresent one of the most frequent complications in course of systemic sclerosis (SSc). They are often disabling and difficult to treat. The upper limb ulcers have been evaluated and characterized extensively, but there are only few studies on lower limb ulcers. SSc is characterized by a microangiopathy that represents the hallmark of disease, but concomitant alterations of arterial, venous and lymphatic circulation may contribute to the pathogenesis of the lower limb cutaneous lesions.  The aim of the study is to assess the pathogenesis, characteristics and time to healing of the lower limb cutaneous lesions in course of SSc.

Methods:

Fifthy-seven consecutive SSc patients with lower limb cutaneous lesions were followed up for four years. All patients performed an accurate health examination and evaluation of cutaneous lesions, routine blood and urine tests with autoantibodies, lipid and glycemic profile and creatinine clearance, videocapillaroscopy and arterial and venous lower limb Color Doppler Ultrasonography. Arteriography was performed in  patients with occlusive peripheral arterial disease. 

Results:

Four hundred and twenty-four (424) lower limb cutaneous lesions were observed. Lesions were divided into: hyperkeratosis, ulcers (loss of tissue) and gangrene. We observed: 275 (64,9%) hyperkeratosis, 144 (33,9%) ulcers and 5 (1,2%) gangrene. The ulcers were subsetted in: primary ulcers (107 (74,3%)), ulcers secondary to hyperkeratosis (17 (11,8%)) and ulcers secondary to calcinosis (20(13,9%)). The mean time to healing was 152 ± 202 days, and recurrence was observed in  31,6% of lesions. The prevalence of amputations was 1,2%.  As regards pathogenesis, 16 (28,1%) patients had a significative peripheral arterial disease,  22 (38,6%) had  venous insufficiency and  7 (12,4%) presented lymphedema, besides the microangiopathy. Three patients presented simultaneously a peripheral arterial disease and venous pathology.  One patient presented  lymphedema and venous insufficiency and two patiens had lymphedema and peripheral arterial disease. Four patients with critical arterial stenosis performed the lower limb angiography which confirmed the presence of stenosis with distal distribution.  

Conclusion:

Our data indicate that lower limb lesions have often a multifactorial pathogenesis in SSc. This is the first study that characterized extensively a large number of lower limb cutaneous lesions in SSc. The comprehension of characteristics and pathogenesis of these lesions is essential for their correct management.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-lower-limb-cutaneous-ulcers-in-systemic-sclerosis-the-analysis-of-424-lesions/