Systemic sclerosis is a chronic autoimmune condition of the connective tissue characterized by the appearance of inflammatory changes, vascular abnormalities and fibrosis, often with a multisystemic involvement. The ongoing vasculopathy, along with functional vasoconstriction and tissular damage, predisposes to ischemia, necrosis and skin ulcers. There is little information in the scientific literature regarding the benefits of negative pressure therapy in the healing process of skin ulcers in patients with systemic sclerosis.
We report the case of a 49-year-old female patient, who presented in our dermatology department for painful bilateral plantar ulcers, the first one progressing for 9 months, with local signs of infection and a recent rapid unfavorable evolution. The presence of Raynaud’s phenomenon, sclerodactyly and post-ulcerative digital scar lesions on both hands, specific facial skin changes, specific autoimmune positive tests (positive antinuclear antibodies, positive Anti-SCL-70 antibodies), histopathological examination and investigations to assess disease extension (cardio-vascular, pulmonary and others) confirmed the diagnosis of severe systemic sclerosis with vascular, lung and skin involvement. Arterial and venous Doppler ultrasound examination of the lower limbs revealed the presence of femoral vascular axes stenosis and the presence of distal popliteal and interdigital flows. The bacteriological examination revealed an infection of skin ulcers with Staphylococcus aureus and Streptococcus agalactiae.
Therapeutic management was complex by merging systemic treatment (antibiotic therapy according to antibiogram results, alprostadil vasodilator treatment) with local therapy (surgical debridement, topical antiseptics, topical application of skin-neutral ointment dressing in adittion to negative pressure wound therapy). The evolution was favorable with complete wound healing within 3 weeks.
In conclusion, negative pressure therapy has proven to be beneficial in healing plantar ulcers in a systemic sclerosis patient by: diminishing pain, removing the exudate, stimulating the development of granulation tissue and maintaining a sterile optimal local environment throughout the whole healing process.