Autoimmune ulceration of the leg

Goslen, J. Blake

doi:10.1016/0738-081x(90)90050-b

Cited by 19 publications

(27 citation statements)

References 134 publications

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“…Typically, histologic examination of wounds in SLE shows a leukocytoclastic vasculitis with fibrinoid necrosis of the vessel wall and prominent polymorphonuclear cell infiltration. Thromboocclusive histologic findings can be associated with the presence of antiphospholipid antibodies(18). Venous insufficiency may also play a role in delayed healing in lupus patients(19).…”

Section: Leg Ulcers Associated With Systemic Lupus Erythematosusmentioning

confidence: 99%

Vasculitic and autoimmune wounds

Shanmugam

Angra

Rahimi

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Chronic wounds are a major cause of morbidity and mortality. Approximately 20–23% of non-healing wounds that are refractory to vascular intervention have other etiologies including vasculitis, pyoderma gangrenosum and other autoimmune diseases. The purpose of this article is to review the autoimmune and coagulopathic diseases that are commonly associated with leg ulceration. OBJECTIVES To review the literature across medical and surgical specialties with regards to refractory chronic wounds associated with vasculitis and autoimmune diseases and to delineate clinical outcomes of these wounds in response to vascular and other interventions. METHODS An electronic search encompassing MEDLINE®, PubMed®, Cochrane Library and Scopus ® was completed using the following search terms: rheumatoid arthritis; systemic sclerosis; systemic lupus erythematosus; ANCA associated vasculitis; mixed connective tissue disease; antiphospholipid syndrome; pyoderma gangrenosum; thromboangiitis obliterans; cryoglobulinemia; hydroxyurea; sickle-cell; atrophie blanche; livedoid vasculitis; cholesterol emboli; calciphylaxis; antiphospholipid antibodies; prothrombotic; combined with the terms: chronic wound and leg ulcer. Full text articles published in English up to March 1, 2016 that investigated the clinical outcomes of chronic wounds associated with autoimmune diseases were included. Review articles and evaluations of management of chronic wounds were also reviewed. Primary outcomes included in the review were amputation, ulcer healing, reduction in wound size, overall survival and freedom from reintervention. Owing to the heterogeneity of data reporting among articles, qualitative analysis is also reported. CONCLUSIONS Autoimmune and vasculitic etiologies should be considered in patients with chronic wounds who do not respond to appropriate vascular intervention and standard local wound care. A multidisciplinary approach with the involvement of rheumatology allows investigation for underlying systemic disease and improves clinical outcomes for many of these challenging patients.

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Section: Leg Ulcers Associated With Systemic Lupus Erythematosusmentioning

confidence: 99%

Vasculitic and autoimmune wounds

Shanmugam

Angra

Rahimi

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…Histologic examination of wounds in SLE shows a leukocytoclastic vasculitis with fibrinoid necrosis of the vessel wall and prominent polymorphonuclear cell infiltration. Coexistent prothrombotic states such as antiphospholipid syndrome may also play a role in some patients (17, 18) and thromboocclusive histologic findings should prompt additional work up (5). Treatment of wounds in patients with SLE should focus on the management of the underlying autoimmune and inflammatory disease.…”

Section: Overview Of Vasculitic Woundsmentioning

confidence: 99%

“…These wounds significantly impact mortality (2) psychosocial wellbeing and quality of life (3). While large epidemiologic studies show that up to 79.7% of leg ulcers have a vascular etiology (4) (venous, peripheral arterial disease or mixed), approximately 6.6% of patients presenting to a dermatology clinic with chronic wounds have associated autoimmune disease (5). Similar epidemiologic studies conducted in dedicated wound healing clinics have found that up to 20 – 23% of patients with chronic wounds have associated autoimmune diseases including vasculitis, rheumatoid arthritis, scleroderma, systemic lupus erythematous, psoriasis, and pyoderma gangrenosum (4, 6).…”

Section: Introductionmentioning

confidence: 99%

Vasculitic Diseases and Prothrombotic States Contributing to Delayed Healing in Chronic Wounds

Shanmugam

2016

Curr Derm Rep

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PURPOSE Autoimmune diseases are a common cause of delayed wound healing and should be considered in patients with chronic wounds who do not respond to local wound care or who fail skin grafting in the absence of infection. RECENT FINDINGS Epidemiologic studies have shown that, of patients with chronic wounds evaluated in specialized wound healing clinics, 20–23% have autoimmune etiologies for their wounds including vasculitis, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, pyoderma gangrenosum and other autoimmune diseases. SUMMARY In this article autoimmune diseases known to be associated with chronic wounds and delayed wound healing are reviewed and the importance of a multidisciplinary approach for patients with chronic wounds, with involvement of rheumatology and dermatology is highlighted. This approach allows for investigation of underlying systemic disease and improves clinical outcomes for many of these challenging patients.

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“…Bei der Sklerodermie können neben einer Vaskulopathie eine Vaskulitis, eine chronischvenöse Insuffizienz oder eine periphere arterielle Verschlusskrankheit zu Unterschenkelulzera beitragen [5]. Es fanden sich in der Sonographie keine Hinweise auf eine venöse Insuffizienz oder eine arterielle Verschlusskrankheit.…”

Section: Diskussionunclassified

“…Hautulzera zeigen aufgrund einer Vaskulopathie, die mit einer gesteigerten Vasokonstriktion, Endothelschä-digung, Intimaproliferation und -fibrose einhergeht, eine schlechte Heilungstendenz und führen oft zu einer beträcht-lichen Morbidität [5,9]. Zur Behandlung von Unterschenkelulzera werden bei Kollagenosen aufgrund der Erfahrungen aus der Therapie akraler Ulzera bei der Sklerodermie potente Vasodilatatoren wie das Prostazyklin-Analogon Iloprost eingesetzt [3,8,10].…”

Section: Diskussionunclassified

Unterschenkelulzera bei Sharp-Syndrom

Becker

Sunderköetter²,

Willeke³

et al. 2009

Z. Rheumatol.

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Leg ulcers may result in serious morbidity in patients with connective tissue diseases and Raynaud's phenomenon (RP). We describe a 35-year-old woman with mixed connective tissue disease who suffered from leg ulcers refractory to iloprost. When the patient was treated with the selective endothelin A receptor antagonist sitaxsentan for pulmonary arterial hypertension, the ulcers improved within 4 weeks and resolved completely thereafter. In addition, severity of RP ameliorated markedly. Further evaluation of sitaxsentan in patients with connective tissue diseases suffering from ischemic skin ulcers is required.

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Autoimmune ulceration of the leg

Cited by 19 publications

References 134 publications

Vasculitic and autoimmune wounds

Vasculitic and autoimmune wounds

Vasculitic Diseases and Prothrombotic States Contributing to Delayed Healing in Chronic Wounds

Unterschenkelulzera bei Sharp-Syndrom

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