Painful cutaneous ulcers are frequent in systemic sclerosis (SSc). They are due to vasoconstriction and fibrosis, and are often located in digits and toes though they also occur at other locations.1 We admitted a 75-year-old patient known to have had limited SSc for 43 years. Her medical history encompassed two earlier admissions for painful digital and leg ulcers during which treatment with opioids resulted in severe obstipation and ileus. This time she presented with a superficial ulcer on the left lower leg with a diameter of 5.5 by 4.5 cm and necrotic borders surrounded by erythaematous and oedematous skin (fig 1 …