Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;52(6):e430-e480.
doi: 10.1111/1346-8138.17703. Epub 2025 Apr 28.

Wound, pressure ulcer, and burn guidelines (2023)-4: Guidelines for the management of connective tissue disease/vasculitis-associated skin ulcers, third edition

Yoshihide Asano  1 , Jun Asai  2 , Takayuki Ishii  3 , Yohei Iwata  4 , Masanari Kodera  5 , Chie Miyabe  6 , Akihiko Uchiyama  7 , Youichi Ogawa  8 , Ken Okamura  9 , Mari Kishibe  10 , Yuta Koike  11 , Yorihisa Kotobuki  12 , Noriki Fujimoto  13 , Takuya Miyagi  14 , Yukie Yamaguchi  15 , Ayumi Yoshizaki  16 , Reiko Omori  16 , Takeshi Nakanishi  17 , Hiroshi Fujiwara  18 , Takeo Maekawa  19 , Sei-Ichiro Motegi  7 , Yuichiro Yoshino  20 , Minoru Hasegawa  21 , Manabu Fujimoto  12 , Takao Tachibana  22 ; Wound, Pressure Ulcer, and Burn Guidelines Drafting Committee (connective tissue disease/vasculitis group)
Affiliations

Wound, pressure ulcer, and burn guidelines (2023)-4: Guidelines for the management of connective tissue disease/vasculitis-associated skin ulcers, third edition

Yoshihide Asano et al. J Dermatol. 2025 Jun.
No abstract available

PubMed Disclaimer

Conflict of interest statement

According to Japanese Association of Medical Sciences (JAMS) Guidelines on COI Management in Medical Research (https://jams.med.or.jp/guideline/index.html) published by JAMS in March 2017, the members of the guideline‐drafting committee disclosed the conflicts of interest (COI) during the past 3 years back to the previous year on assumption as a member and guideline announcement. For reporting: (1) the members' COI, their spouses' COI, (2) first‐degree relatives' or income/financial profit‐sharing persons' COI, and (3) COI of organizations/divisions to which the members belong were reported with an amount classification using the COI self‐disclosure form established in the JAMS Guidelines on COI Management in Medical Research.

Figures

FIGURE 1
FIGURE 1
Therapeutic algorithm for systemic sclerosis–associated skin ulcers. CQ, clinical question.
FIGURE 2
FIGURE 2
Therapeutic algorithm for systemic lupus erythematosus (SLE)–associated skin ulcers.
FIGURE 3
FIGURE 3
Therapeutic algorithm for dermatomyositis‐associated skin ulcers. CQ, clinical question.
FIGURE 4
FIGURE 4
Therapeutic algorithm for vasculitis‐associated skin ulcers. CQ, clinical question.
FIGURE 5
FIGURE 5
Therapeutic algorithm for rheumatoid arthritis (RA)–associated skin ulcers. CQ, clinical question; TNF‐α, tumor necrosis factor α.
FIGURE 6
FIGURE 6
Therapeutic algorithm for antiphospholipid antibody syndrome (APS)–associated skin ulcers. IVIG, intravenous immunoglobulin.
FIGURE 7
FIGURE 7
Clinical question 1 (CQ1): flow chart of the literature search.
FIGURE 8
FIGURE 8
Clinical question 1 (CQ1): forest plot of PDE5 inhibitors (outcome: skin ulcer healing). CI, confidence interval; M‐H, Mantel‐Haenszel.
FIGURE 9
FIGURE 9
Clinical question 1 (CQ1): forest plot of PDE5 inhibitors (outcome: onset of new skin ulcers). CI, confidence interval; M‐H, Mantel‐Haenszel.
FIGURE 10
FIGURE 10
Clinical question 1 (CQ1): total evidence on bosentan. NA, not applicable.
FIGURE 11
FIGURE 11
Clinical question 1 (CQ1): total evidence on PDE5 inhibitors.
FIGURE 12
FIGURE 12
Clinical question 2 (CQ2): flow chart of the literature search.
FIGURE 13
FIGURE 13
SR‐9: qualitative systematic review. CQ, clinical question; RCT, randomized controlled trial.
FIGURE 14
FIGURE 14
SR‐9: qualitative systematic review. CQ, clinical question.
FIGURE 15
FIGURE 15
SR‐9: qualitative systematic review. CQ, clinical question.
FIGURE 16
FIGURE 16
SR‐9: qualitative systematic review. CQ, clinical question.
FIGURE 17
FIGURE 17
SR‐9: qualitative systematic review. CQ, clinical question; QOL, quality of life.
FIGURE 18
FIGURE 18
SR‐9: qualitative systematic review. CQ, clinical question; SSc, systemic sclerosis.
FIGURE 19
FIGURE 19
SR‐9: qualitative systematic review. CQ, clinical question.
FIGURE 20
FIGURE 20
Clinical question 3 (CQ3): flow chart of the literature search.
FIGURE 21
FIGURE 21
SR‐9: qualitative systematic review. CQ, clinical question; PSL, prednisolone.
FIGURE 22
FIGURE 22
SR‐9: qualitative systematic review. CQ, clinical question; INR, international normalized ratio.
FIGURE 23
FIGURE 23
Clinical question 4 (CQ4): flow chart of the literature search.
FIGURE 24
FIGURE 24
SR‐9: qualitative systematic review. CQ, clinical question; PSL, prednisolone; RCT, randomized controlled trial; RV, rheumatoid vasculitis.
FIGURE 25
FIGURE 25
SR‐9: qualitative systematic review. CQ, clinical question; QOL, quality of life; RV, rheumatoid vasculitis.
FIGURE 26
FIGURE 26
SR‐9: qualitative systematic review. BVAS, Birmingham Vasculitis Activity Score; CQ, clinical question; N/A, not available; RV, rheumatoid vasculitis; TNFα, tumor necrosis factor α; RV, rheumatoid vasculitis.
FIGURE 27
FIGURE 27
SR‐9: qualitative systematic review. BVAS, Birmingham Vasculitis Activity Score; CQ, clinical question; GC, glucocorticoids; N/A, not available; RV, rheumatoid vasculitis.
FIGURE 28
FIGURE 28
SR‐9: qualitative systematic review. AZA, azathioprine; CY, cyclophosphamide; GCAP, granulocytapheresis; LCAP, leukocytapheresis; N/A, not available; QOL, quality of life; RV, rheumatoid vasculitis.
See this image and copyright information in PMC

References

    1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised international Chapel Hill consensus conference nomen‐clature of vasculitides. Arthritis Rheum. 2013;65:1–11. - PubMed
    1. Furukawa F, Ikeda T, Ishiguro N, Uzuki M, Ozaki S, Katsuoka K. Guidelines for the management of vasculitis and vasculopathy (2016 revision). Jpn J Dermatol. 2017;127:299–415. - PubMed
    1. Wattiaux MJ, Kahn MF, Thevenet JP, Sauvezie B, Imbert JC. Vascular involvement in rheumatoid polyarthritis. Retrospective study of 37 cases of rheumatoid polyarthritis with vascular involvement and review of the literature. Ann Med Interne (Paris). 1987;138:566–587. - PubMed
    1. Salvarani C, Macchioni P, Mantovani W, Rossi F, Veneziani M, Boiardi L, et al. Extraarticular manifestations of rheumatoid arthritis and HLA antigens in northern Italy. J Rheumatol. 1992;19:242–246. - PubMed
    1. Kaye O, Beckers CC, Paquet P, Arrese JE, Piérard GE, Malaise MG. The frequency of cutaneous vasculitis is not increased in patients with rheumatoid arthritis treated with methotrexate. J Rheumatol. 1996;23:253–257. - PubMed

LinkOut - more resources