Medical and Surgical Treatment of Vasculitic and Autoimmune Ulcers

Chronic wounds of autoimmune and vasculitic etiologies, collectively referred to as “atypical ulcers”, are complex and heterogeneous. Evidence for a standardized approach remains deficient. Diagnosis requires a thorough history, physical exam, and investigative studies including serologic tests and wound biopsies. Management must be multidisciplinary and tailored to the individual patient and the unique characteristics of their wound. Medical therapy to stabilize the underlying disease is the most important aspect of therapy. Surgical intervention is often not appropriate and even contraindicated in some scenarios such as pyoderma gangrenosum. When medical therapy and local wound care fail and surgical intervention is deemed appropriate, inflammation must first be controlled with medical intervention before surgical intervention can be considered. This review contains 5 figures, 2 tables, and 26 references. Keywords: ulcer, wound healing, autoimmune diseases, vasculitis, pyoderma gangrenosum, scleroderma, rheumatoid nodule, immunosuppressive agents, rheumatology, patient care team