Department of Dermatology, Tenon Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France.
Acta Derm Venereol. 2018 Jul 11;98(7):677-682. doi: 10.2340/00015555-2939.
Lower-limb ulcers in systemic sclerosis patients are rarely reported. The aim of this study was to describe the main causes and outcomes of lower-limb ulcers in systemic sclerosis patients and to assess factors associated with ischaemic causes (arterial disease and/or microvascular impairment). A retrospective, multicentre, case-control study was conducted in 2013 and 2014, including 45 systemic sclerosis patients presenting lower-limb ulcers between 2008 and 2013. The estimated prevalence of lower-limb ulcers among systemic sclerosis patients was 12.8%. Ulcers were related to venous insufficiency in 22 cases (49%), ischaemic causes in 21 (47%) and other causes in 2 (4%). Complete healing was observed in 60% of cases in a mean time of 10.3 months; 59% relapsed during a mean follow-up of 22 months. Ischaemic lower-limb ulcer outcomes were poor, with a 28.6% amputation rate. Logistic-regression multivariate analyses between ischaemic lower-limb ulcer cases and matched systemic sclerosis-controls identified past or concomitant digital ulcer and cutaneous sclerosis of the feet as independent risk factors associated with ischaemic lower-limb ulcers.
系统性硬化症患者下肢溃疡很少见。本研究旨在描述系统性硬化症患者下肢溃疡的主要病因和转归，并评估与缺血性病因（动脉疾病和/或微血管损伤）相关的因素。这是一项 2013 年至 2014 年进行的回顾性、多中心、病例对照研究，纳入了 2008 年至 2013 年间出现下肢溃疡的 45 例系统性硬化症患者。下肢溃疡在系统性硬化症患者中的估计患病率为 12.8%。溃疡与静脉功能不全有关的有 22 例（49%），与缺血性病因有关的有 21 例（47%），与其他病因有关的有 2 例（4%）。平均 10.3 个月时，60%的病例完全愈合；平均随访 22 个月时，59%的病例复发。缺血性下肢溃疡的结局较差，截肢率为 28.6%。缺血性下肢溃疡病例与匹配的系统性硬化症对照组之间的多变量逻辑回归分析确定，既往或同时存在的指端溃疡和足部皮肤硬化是与缺血性下肢溃疡相关的独立危险因素。
