Reactive arthritis or Reiter’s syndrome (RS) is triad of reactive arthritis and conjunctivitis following urogenital or gastrointestinal tract infection. Patients with RS may have superficial painless oral and genital ulcers. The genital ulcers in the male have a characteristic of circinate white plaques that grow centrifugally on the uncircumcised glans penis (circinate balanitis).

Systemic lupus erythematosus (SLE) . Digital ulceration is a rare manifestation of SLE. It occurs most commonly in patients with disease of long duration and may be the result of vasculitis, the presence of antiphospholipid antibody, or atherosclerosis. In addition to digital ulcers, sometimes panniculitis and vasculitis can lead to ulceration. Lupus panniculitis occurs on the face, the breast, the abdomen, and thighs and is seen in 2–5 % of SLE patients. Vasculitis may cause lower leg ulceration.

Systemic sclerosis (SSc) . The most common type of ulceration in SSc is the digital ischemic lesion (DIL). These ulcerations occur in up to 40 % of patients with SSc and can be extremely debilitating due to pain. The lesions come in two forms: those occurring on the digital pulp and those occurring overlying extensor joints (such as the interphalangeal joints or metacarpophalangeal joints). The digital pulp lesions usually occur on the digital tips, although they can occur at the hyponychium (the junction of the free edge of the nail plate and the fingertip) or on the lateral tips of the digit. They present as punctate ulcerations filled with a hyperkeratotic inclusion without surrounding erythema and are usually quite tender. They resolve with a pitted scar. The other type of lesion overlying the extensor joints typically presents as true ulcerations, which can often be associated with some crust and/or eschar. They often heal with lacy telangiectasias. In addition to being found on the hands, they are also seen overlying the elbows, knees, and malleoli. These lesions are likely the result of a combination of trauma and poor blood supply.

Another cause of ulceration in the SSc patient is pyoderma gangrenosum. These commonly present as ulcers on the leg with a rolled, inflammatory border and they can change in size quickly.