Digital Ulcerations and Classification of SSc Subsets and Overlap Syndromes

Abstract

In the earliest classification of systemic sclerosis (SSc), which was developed in 1980 by the American College of Rheumatology (ACR), digital pits but not digital ulcerations (DUs) were considered as a characteristic disease parameter. The classification of SSc, which was proposed in 1988 by LeRoy et al., distinguished between the limited cutaneous and diffuse cutaneous subset of SSc. Although DUs were not part of the original description of LeRoy et al., many studies using this classification observed that DUs occur significantly earlier and more often in the diffuse cutaneous SSc subset than in the limited cutaneous subset. In 2013, the new ACR/EULAR criteria for classification of systemic sclerosis for the first time included DU as an item of criteria developed to identify individuals with SSc.