Lower Limb Ulcers

Lower limb ulcers may represent real clinical challenge in patients with systemic sclerosis (SSc). They are often multifactorial, long-lasting and difficult to treat. In addition to microangiopathy, macrovascular arterial and venous involvement may overlap and cause ulcer formation. Other local factors, as calcinosis and hyperkeratosis can contribute. Several types of lesions with different aetiology may occur, even in the same patient. Systematic clinical evaluation and diagnostic work-up are mandatory for proper ulcer classification that is essential for their management, since diverse lesions may require different treatment.The learning objectives of this chapter are to understand etiopathogenesis of lower limb ulcers in SSc, to comprehend their clinical assessment and management.