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CLINICAL REPORT
Lower-limb Ulcers in Systemic Sclerosis: A Multicentre Retrospective
Case-control Study
Gérôme BOHELAY 1 , Sophie BLAISE 2 , Pierre LEVY 3 , Antoine CLAEYS 4 , Nathalie BAUDOT 1 , Jean-Francois CUNY 5 , Hervé
MAILLARD 6 , Florence GRANEL-BROCARD 5 , Thierry BOYÉ 7 , Catherine LOK 8 , Nathalie BÉNÉTON 6 , Camille FRANCÈS 9 and
Patricia SENET 1 ; on behalf the Angio-Dermatology Group of the French Society for Dermatology
Department of Dermatology, Tenon Hospital, Public Assistance – Paris Hospitals (AP-HP), Paris, 2 Vascular Medicine Department, Grenoble
University Hospital, Grenoble, 3 Department of Public Health, Tenon Hospital, AP-HP, Pierre and Marie Curie University, and the French
National Institute of Health and Medical Research, UMR-S 1136, Paris, 4 Department of Dermatology and Photobiology, Nord Hospital,
Grenoble University Hospital Centre, Grenoble, Departments of Dermatology: 5 Brabois Hospital, Nancy University Hospital Centre, Nancy,
6
Le Mans Hospital, Le Mans, 7 Sainte-Anne Military Hospital, Toulon, 8 Amiens University Hospital, Amiens, and 9 Tenon Hospital, AP-HP, and
Pierre and Marie Curie University, Paris, France
1
Lower-limb ulcers in systemic sclerosis patients are ra-
rely reported. The aim of this study was to describe the
main causes and outcomes of lower-limb ulcers in sys-
temic sclerosis patients and to assess factors associa-
ted with ischaemic causes (arterial disease and/or mi-
crovascular 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 esti-
mated prevalence of lower-limb ulcers among systemic
sclerosis patients was 12.8%. Ulcers were related to
venous insufficiency in 22 cases (49%), ischaemic cau-
ses 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 sclero-
sis-controls identified past or concomitant dig