BACKGROUND: Ischemic ulcers (digital ulcers) are often observed in systemic connective tissue disorders. MATERIAL AND METHODS: This review article is based on a Pubmed search with the terms "digital ulcers" and "ischemic ulcers", and on the authors' clinical experience. RESULTS AND INTERPRETATION: Up to 40 % of patients with systemic sclerosis have digital ulcers. Non-rheumatic causes of compromised blood circulation must be excluded. The treatment consists of analgesics, prevention of cooling and antibiotics if the ulcers are infected. Other possible treatments are vasodilators, prostacyclin analogues, endothelin receptor antagonists, sildenafil and chemical or surgical sympathectomy.