| SKIN INVOLVEMENT: MAIN MENU |
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| Digital (Finger or Toe) Ulcers |
| This page was written by Shelley Ensz, and has not yet been medically edited. Scleroderma (SD) affects everyone differently. Just because something is listed here does not mean an individual patient will ever experience it. See Disclaimer. |
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| What are Digital Ulcers? |
Systemic scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers.
Most people try several methods of dealing with finger ulcers before settling on the system that works best for them. But remember, no treatment for finger ulcers should be undertaken without the supervision of a physician — it's very important to treat finger ulcers properly, to prevent complications such as serious infection, gangrene or possible amputation. |
| Biomarkers of vascular disease in scleroderma. Vascular disease is present in every patient with scleroderma and is a major source of morbidity and mortality. There is a subset of patients who will develop severe and sometimes life-threatening vascular events. (PubMed) Hummers LK. Rheumatology (Oxford). 2008 Oct;47 Suppl 5:v21-2. (Also see: Pulmonary Hypertension) |
| Blunted increase of digital skin vasomotion following acetylcholine and sodium nitroprusside iontophoresis in systemic sclerosis (SSc) patients. This study showed a selective abnormality of the endothelial, sympathetic and myogenic-dependent finger skin vasomotion in SSc patients, consistent with a parallel endothelial, sympathetic and myogenic macrovascular dysfunction. M. Rossi. Rheumatology. April 22, 2008. (Vasomotion is cyclic variation in vascular diameter) (Also see: Raynaud's) |
| Natural History of Ischemic Digital Ulcers (DU) in Systemic Sclerosis: Single-Center Retrospective Longitudinal Study. Development of DU typically occurred within 5 years of the first non-Raynaud clinical symptom of SSc in the majority of patients. J Rheumatol 2007;34:2423-30. |
| Hand vascular involvement assessed by magnetic resonance angiography in systemic sclerosis. Impairment of the microcirculation is a cardinal feature of systemic sclerosis (SSc). Magnetic resonance angiography (MRA) has improved the assessment of vascular lesions of the hand. The aim of this study was to evaluate vascular abnormalities in the hands of patients with SSc, using MRA. (Wiley InterScience) Arthritis & Rheumatism.Volume 56, Issue 8, Pages 2747 - 2754. July 30 2007. (Also see: Raynaud's) |
| Morbidity of Digital Tip Ulcerations in Scleroderma. Persistent digital tip ulcerations and severe digital tip ulcerations are more frequent in patients with anticentromere (ACA) and antitopoisomerase I (TOPO) antibodies, and these patients had significantly more functional disability than those who had never had an ulcer. Kristin M. Ingraham. F58/578 ACR 2006. (Also see: Antibodies) |
| Whole Blood Viscosity (WBV) and Digital Ulcers in Scleroderma Patients. Scleroderma patients have increased WBV relative to healthy controls, and WBV may be highest amongst patients with active digital ulceration. Suncica Volkov. F56/576 ACR 2006. |
| Abnormal microvascular response is localized to the digits in patients with systemic sclerosis (SSc). This study suggests that SSc has no effect on microvascular perfusion in the dorsum of the hand, and that the abnormal microvascular response is localized to the digits, affecting both smaller and larger vessels. Arthritis & Rheumatism Journal. Vol 54, Issue 6:1952 - 1960 June 2006. (Also see: Raynaud's) |
| Arguments dramatically slow wound healing! |
Arguments dramatically slow wound healing. The stress a married couple experiences during a 30-minute argument can delay their bodies’ ability to heal a wound by at least a day, according to a new study. And if the couples’ relationship endures routine hostility, the delay can be even longer. There could be important implications for people suffering from chronic wounds, such as skin ulcers. New Scientist. 12-05-05. (Also see: Causes of Scleroderma: Stress) |
| Assessment of vascular involvement in Systemic Sclerosis. The core set variables include two parameters: Raynaud's phenomenon and digital ulcers. This set is simple, reproducible and should be included in the assessment of SSc patients in clinical investigational studies. PubMed. Clin Exp Rheumatol. 2003;21(3 Suppl 29):S9-14. (Also see: Raynaud's) |
| Pyoderma gangrenosum as initial manifestation of Graves' disease. Pyoderma gangrenosum (PG) is an uncommon ulcerative condition. The report emphasizes that a diagnostics of PG should be considered in patients with Graves' disease and skin ulcers. PubMed. Clin Exp Dermatol. 2006 Sep;31(5):659-61. (Also see: Graves' disease) |
| In patients with systemic sclerosis, two main subsets of vascular acrosyndromes can be found: Raynaud's phenomenon and digital ulcerations. A severe Raynaud's phenomenon is found in almost every patient with systemic sclerosis. PubMed. Rev Prat 2002 Nov 1;52(17):1891-5 (Also see: Raynaud's) |
| Digital Necrosis Related to Carboplatin and Gemcitabine Therapy in Systemic Sclerosis. We present a woman with scleroderma who developed multiple ischemic digits after chemotherapy for lung cancer. Scleroderma patients are at particular risk for digital infarction because of their underlying vascular disease and associated Raynaud's phenomenon. J Rheumatol NO. 6 JUNE 2003;30:1341-3 (Also see: Raynaud's and Cancer and Scleroderma) |
| Peripheral vasculopathy in patients with systemic sclerosis: Difference in limited and diffuse subset of disease. Severe capillary damage and digital ulcers are more common in patients with diffuse cutaneus systemic sclerosis, but finger-tip osteolysis and telangiectasias are equally frequent in both form of disease. PubMed. Clin Hemorheol Microcirc. 2004;31(4):281-5. (Also see: Types of Scleroderma) |
| Capillaroscopy for Digital Ulcers |
| Correlation of a Quantitative Videocapillaroscopic Score with the Development of Digital Skin Ulcers in Scleroderma (SSc) Patients. This capillaroscopic score may represent a feasible and simple tool in SSc patients' assessment. The routinely use of this parameter might permit to recognize and to preventively treat SSc patients at high risk to develop digital ulcers. M. Sebastiani. SAT0222. EULAR 2008. |
| Photos of Digital Ulcers |
 Digital (Finger) Ulcers Scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers. No treatment for finger ulcers should be undertaken without the supervision of a physician — it's very important to treat finger ulcers properly, to prevent complications such as serious infection, gangrene or possible amputation. ISN Photo Repository, contributed by Cindy G. |
 Digital (Finger) Ulcer from Mixed Connective Tissue Disease (MCTD). This digital ulcer is 14 weeks old. It was caused by secondary Raynaud's phenomenon, in a patient with Mixed Connective Tissue Disease (MCTD). The MCTD was diagnosed 5 years ago, after thyroid gland removal. ISN Photo Repository, contributed by Jeanne N. |
 Digital Ulcer from Mixed Connective Tissue Disease (MCTD). When I was eighteen my rheumatologist diagnosed me with rheumatoid arthritis. Later at the age of twenty-one, another doctor said it looks more like C.R.E.S.T. Scleroderma. Now I'm twenty-six and the same doctor who diagnosed me with rheumatoid arthritis says its mixed connective tissue disease (MCTD). ISN Photo Repository, contributed by Rosemarie. |
 Photo of Leg Ulcer This is a very large chronic leg ulcer in a Systemic Sclerosis patient, which has not responded to treatment. ISN Photo Repository, contributed by Sylvia Finegan. |
| Treatments |
The best treatment for digital ulcers is to prevent them from occurring in the first place. Since many digital ulcers are directly related to frequent Raynaud's episodes, it is important to follow the Raynaud's prevention techniques the help to reduce Raynaud's episodes and intensity.
It cannot be emphasized enough that scleroderma finger ulcers are not a do-it-yourself project. Do not attempt any of the ideas listed here (or elsewhere on the Internet) without consulting your doctor first. |
| Management of cutaneous vascular complications in systemic scleroderma: experience from the German network. Management of Raynaud's Phenomenon and ulcerations in SSc were heterogeneous at initiation of the network, reflecting a sometimes insufficient use of the diagnostic and therapeutic possibilities. (PubMed) Rheumatol Int. 2008 Mar 5. (Also see: Raynaud's) |
| Exercise may play role in reducing inflammation in damaged skin tissue. “The key point of the study is that moderate exercise sped up how fast wounds heal in old mice,” said researcher K. Todd Keylock, who noted that the improved healing response “may be the result of an exercise-induced anti-inflammatory response in the wound.” News Bureau, University of Illinois 11/28/07. |
| Assessment of abnormal blood flow and efficacy of treatment in patients with systemic sclerosis using a newly developed microwireless laser Doppler flowmeter and arm-raising test. Cutaneous blood flow (CBF) assessment using micromachined integrated laser blood flowmeter and an arm-raising test is accurate, noninvasive and well tolerated and thus the combination may be a better alternative method to evaluate abnormal CBF and efficacy of treatment in patients with SSc. British Journal of Dermatology, Vol 157, No 4, Oct 2007, pp. 690-697(8). |
| Therapeutic management of acral manifestations of systemic sclerosis. Acral manifestations of systemic sclerosis include Raynaud's phenomenon, calcinosis cutis, and sclerodactyly. In the later stages of the disease, contractures of the skin and joints as well as obliterative vasculopathy leading to digital ulcers and necrotic lesions may occur. PubMed. Med Klin (Munich). 2007 Mar 15;102(3):209-18. (Also see: Raynaud's, Calcinosis, Sclerodactyly, and Skeletal Involvement: Joint Contractures) |
| Ischemic ulcers in systemic connective tissue disorders. 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. PubMed. Tidsskr Nor Laegeforen. 2006 Nov 30;126(23):3089-92. |
 Scleroderma Care and Research Journal (PDF) This journal for physicians focuses on elevating the standards of care for digital ischemia in scleroderma. Articles include The Genetics of Scleroderma: What Every Rheumatologist Should Know, as well as Digital Ulceration and Critical Digital Ischemia in Scleroderma. Journal of the Scleroderma Clinical Trials Consortium (SCTC) Vol 1, No. 2, Winter 2003 (Also see: Genetics and Scleroderma and Scleroderma DNA and Family Registry) |
| Wound Care Centers |
| Many times Scleroderma skin ulcers are treated at wound care centers. Follow your doctor's advice carefully for healing wounds. And remember this rule of thumb: |
"If it has not started healing in a month,
it's not healing — it's getting worse!" |
| Alternative Treatments |
| Ancient Healing Power: Honey Makes Sweet Comeback In Treating Advanced Wounds. Clinical studies of MEDIHONEY™ have shown it has promise over current treatments because of its strong wound healing benefit. Medical News Today. 10/24/07. |
| Effect of Clonazepam on Raynaud's Phenomenon and Fingertip Ulcers in Scleroderma. We report a case of Raynaud's phenomenon and digital ulcers responding to clonazepam. Further research is warranted to test the robustness of this preliminary finding. The Annals of Pharmacotherapy: Vol. 41, No. 9, pp. 1544-1547. 2007. (Also see: Raynaud's) |
| NZ manuka honey wound dressing wins approval from US authority. Bee products company Comvita says its patented "advanced wound care dressing" has become the first using manuka honey for wounds and burns to receive marketing clearance from the US Food and Drug Administration. Wound-care products using the honey have become increasingly valuable, as they have also been effective against some antibiotic-resistant strains of bacteria. The New Zealand Herald. 07/25/07. |
| Antibiotics |
| Antibiotics are sometimes necessary for the treatment of digital ulcers. |
| Apligraf |
| On 5-26-98, the FDA approved Apligraf, a new interactive wound dressing, for treatment of skin ulcers which are caused by insufficient blood flow. ApliGraf is made out of living, human cells, so its all-natural and never has to be removed after application. |
| Amputation |
| Gangrene (Death of Tissue) and Amputation. Digital ulcers can develop gangrene and lead to amputation. Thus Raynaud's prevention and prompt and careful treatment of digital ulcers is absolutely essential. ISN. |
| Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting. Exposure of bone marrow cells plus an occlusive dressing accelerates the healing of skin ulcers. PubMed. Br J Dermatol. 2005 Apr;152(4):664-72. (Also see: Gangrene and Amputation) |
| Blood Thinners (Coumadin, Warfarin) |
| Long-Term Warfarin Treatment for Severe Raynaud's Phenomenon and Ischemic Skin Ulcers: An Open Study. This open study suggests that Wf is safe and potentially beneficial in patients with severe RP and ISU due to coagulation abnormalities or secondary to SSc. A. Balbir-Gurman. FRI0153 EULAR 2005. (Also see: Raynaud's Treatments, Digital Ulcers, and Dr. Alexandra Balbir-Gurman) |
| Bosentan, Tracleer, Endothelin Receptor Antagonist (ERA) |
| Scleroderma Treatments: Bosentan. Digital ulcers in patients with systemic sclerosis (scleroderma) can be prevented and treated with bosentan. In addition, it appears to be effective for many other symptoms of systemic scleroderma. |
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| Tracleer® (Bosentan) Receives New Indication In Patients With Systemic Sclerosis And Active Digital Ulcer Disease. Actelion Pharmaceuticals UK Ltd announced that Tracleer® (bosentan), a dual endothelin receptor antagonist, has been approved in the UK and Ireland for the reduction of the number of new digital ulcers (DUs) in patients with systemic sclerosis (SSc) and ongoing DU disease. Medical News Today. 04/28/08. (Also see: Bosentan) |
| Long-term experience of bosentan for treating ulcers and healed ulcers in systemic sclerosis patients. Bosentan may be a safe long-term alternative for treating the recurrence of skin ulcers and healed ulcers in SSc patients. Rheumatology 2008 47(4):464-466. (Also see: Bosentan) |
| Bosentan (Tracleer) Receives European (EU) Approval for Reduction of Number of New Digital Ulcerations in Systemic Sclerosis Patients. Digital ulcers are an important and painful complication of systemic sclerosis with approximately 50 percent of people with systemic sclerosis developing digital ulcers during their lifetime. PrimeNewswire. Actelion Ltd. 06/11/07. (Also see: Bosentan) |
| Bosentan Reduces the Number of New Digital Ulcers in Patients with Systemic Sclerosis - Open Label Extension to a Double-Blind Trial. The sustained reduction in the number of new DUs and improvement of hand function suggest the maintenance of bosentan’s beneficial clinical effects after long- term exposure. C. Black. FRI0325 EULAR 2006. (Also see: Clinical Trials and Professor Carol Black) |
| Long-Term Safety and Drug Survival of Bosentan in Patients with Systemic Sclerosis. Bosentan survival has been high and similar to previous data from patients with primary PAH due to SSc. A close monitoring of liver enzymes is mandatory throughout the first year of treatment.. J. J. Alegre-Sancho. AB0260 EULAR 2006. (Also see: Clinical Trials) |
| Bosentan for treatment of active digital ulcers in patients with systemic sclerosis (SSc). Bosentan can be effective in the treatment of digital ulcers in some SSc patients, especially those involving substantial ischemia. Forthcoming results from the international RAPIDS-2 study should clarify the indications for bosentan in the treatment of SSc-related digital ulcers. PubMed. Presse Med. 2006 Apr;35(4 Pt 1):587-92. |
| Digital Ulcers in Systemic Sclerosis: Effectiveness by Treatment with Bosentan. In our series, at 6 months of treatment we have observed a important decrease in the number of digitital ulcers and scars in those patients. In general terms, we can say that bosentan was well tolerated, having only one severe adverse effect. P. García de la Peña Lefebvre. FRI0161 EULAR 2005. (Also see:Scleroderma Treatments: Bosentan) |
| Long-Term Efficacy and Safety of Bosentan in the Treatment of Ischemic Digital Ulcers due to Severe Raynaud's Phenomenon in Patients with Systemic Sclerosis. Severe Raynaud’s phenomenon and IDU in patients with SSc can be successfully prevented and treated with bosentan. Efficacy and safety of this drug remains beyond 18 months of therapy. J. J. Alegre-Sancho. FRI0099 EULAR 2005. (Also see: Raynaud's and Scleroderma Treatments: Bosentan) |
| Creams and Solutions |
| Generic Names |
Brand Names |
| povidone-iodine solution |
Betadine Solution ® |
| sodium hypochlorite-diluted |
Dakin's Solution ® |
| hydrogen peroxide solution (1.5%-3.0%) |
|
| silver sulfadiazine cream |
Silvadene ®. |
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| The Topical Application of Vitamin E Gel Reduces the Time of Healing in Digital Ulcers of Hands in Systemic Sclerosis (SSc) Patients. D-alpha- tocopheryl acetate gel on digital ulcers of SSc patients leads to resolution of pain and to ulcer healing in almost half of the time of standard topical treatments. G. Fiori. FRI0350 EULAR 2006. |
| Endothelin Receptor Antagonist (ERA) - Also see Bosentan, Tracleer |
| Also see Bosentan, Tracleer. |
| Flexible Hydroactive Dressings (1) |
| Treatment of scleroderma skin ulcers using becaplermin gel and hydrocolloid membrane. This case study demonstrates the effectiveness of becaplermin gel supplemented by oral immunosuppressive agents in the treatment of ulcers resulting from systemic sclerosis. J Am Podiatr Med Assoc 2002 Jun;92(6) :350-4 PubMed. |
| Flolan, Epoprostenol, Prostaglandins |
| Intravenous Epoprostenol for Severe Digital Ischemia in Scleroderma. Intravenous epoprostenol appears to be an effective therapy for severe digital ischemia associated with scleroderma unresponsive to conventional therapies including oral vasodilators and sympathetic blockade. When administered early in the course of severe digital ischemia, it may act to reverse severe digital vasospasm before permanent tissue injury and gangrene develop. Robert W. Simms. 1702/527. ACR 2004. |
| Hyperbaric Oxygen Therapy |
| Hyperbaric oxygen therapy (HBOT) . Foot wounds from diabetes, radiation ulcers, and other ischemic wounds have been manipulated and successfully treated with HBO. However, HBOT is not without side effects. Side effects include oxygen toxicity as well as barotrauma, a physical damage to body tissue caused by pressure differences inside and outside the body. eMedicine.com. July 21,2005. |
| Ischemic Scleroderma Wounds Successfully Treated with Hyperbaric Oxygen Therapy (HBOT) - Case Report: This is the first reported successful use of HBOT to treat scleroderma ulcers, and may represent an unrecognized treatment option for these notoriously difficult chronic wounds. J Rheumatol 2006 August;33:1694–6. |
| Iloprost |
| Digital ulcers and outcomes assessment in scleroderma.. Healing has been demonstrated with intravenous iloprost and two studies with bosentan have demonstrated reduction in the occurrence of new digital ulcers (DUs) over 4-6 months of treatment. (PubMed) Matucci-Cerinic M. Rheumatology (Oxford). 2008 Oct;47 Suppl 5:v46-7. (Also see: Bosentan) |
| Low versus High-dose Iloprost Therapy Over 21 Days in Patients with Secondary Raynaud's Phenomenon and Systemic Sclerosis: A Randomized, Open, Single-center Study. Low-dose iloprost was shown to be equally effective as high-dose iloprost in longterm treatment and was very effective in therapy of digital ulcers. A. Kawald. J Rheumatol. July 15 2008. (Also see: Scleroderma Treatments, Raynaud's,and Skin Fibrosis). |
| Disease Modifying Effect Of Iloprost Infusions In Scleroderma. The results confirm the clinical observation of immediate improvements in Scleroderma hand puffiness following Iloprost infusions. The complementary findings of improved mobility supports this conclusion. Iloprost seems to reduced vascular permeability in addition to causing vasodialatation suggesting a disease modifying effect in Scleroderma. C. N. A. Rajapakse AB0522 EULAR 2007. (Also see: Raynaud's) |
| Therapy with Iloprost in Patients with Severe Raynaud's Phenomenon Secondary to Scleroderma. Venous inffusion of Iloprost reduces frequency and severity of vasospastic episodes, relieves the pain and heals digital ulcers. S. N. Lambova. FRI0368 EULAR 2006. (Also see: Raynaud's: Treatments) |
| Treatment of therapy-resistant acral ulcers with iloprost. We investigated the effects of iloprost infusion on the acral ulcers and necrosis in patients with five patients with SSc and one with mixed connective tissue disease who had been previously treated with various modalities without improvement. In all cases acral ulcers healed completely and no patient relapsed during an observation period of 6 months. PubMed. Hautarzt. 2004 Dec;55(12):1150-3. |
| Safety of Iloprost Infusion in Systemic Sclerosis (SSc). Iloprost is currently used to control Raynaud's and is useful in the treatment of fingertip ulcers. Iloprost should be managed with care and the traditional dosage needs to be tailored to the phase of the disease in order to avoid side effects that may lead to drug discontinuation. D. Melchiorre. FRI0344 EULAR 2004. (Also see: Raynaud's Treatments) |
| Systemic sclerosis is an autoimmune disease of unknown origin affecting multiple organ systems. Iloprost, a stable prostacyclin analogue, with its antifibrotic effect can influence an important step in the pathogenesis of systemic sclerosis. PubMed. Hautarzt. 2003 Sep;54(9):845-51. (Also see: Raynaud's Treatments) |
| Safety and efficacy of iloprost for the treatment of ischaemic digits in paediatric connective tissue diseases. Iloprost appears to be a safe and effective treatment for ischaemic digits and digital ulcers in children with CTD. In conjunction with immunosuppressive drugs, it has a potential role in preventing irreversible complications, such as digital gangrene and amputation. PubMed. Rheumatology (Oxford). 2003 Aug 15 (Also see:Juvenile Scleroderma) |
| Iloprost Has Long-Term Benefits For Systemic Sclerosis Patients Long-term therapy with iloprost has a ''durable effectiveness'' on ischaemic ulcers and Raynaud's phenomenon in patients with systemic sclerosis, a study in Italy has found. Clinical Rheumatology Volume 21 Issue 3 (2002) pp 244-250. Doctor's Guide 7-25-02. |
| Infliximab, Remicade, Anti-TNF (Tumor necrosis factor-a antibody) |
| The effect of infliximab on skin lesions in a patient with scleroderma (CREST). We present a patient with scleroderma (CREST) and refractory skin lesions. Infliximab combined with methotrexate (MTX) was well tolerated and effective in the healing of ulcerative lesions. Arthritis Res Ther 2004, 6(Suppl 1):93. |
| The Therapeutical Effect of Infliximab on Skin Lesions in Limited Cutaneous Systemic Scleroderma (Crest). We present the case of a forty-six-year-old female patient with limited cutaneous systemic scleroderma (CREST). Because of refractory skin lesions (necrosis and ulcerations), she was treated with infliximab (3 mg/kg) at baseline, week 2, week 6 and week 14, in association with methotrexate. Infliximab treatment was well tolerated and effective in the healing of ulcerative lesions and wound healing after fingertip amputation. L. De Rycke. AB0335 EULAR 2003. |
| Intermittent Pneumatic Compression (IPC) |
| Use of intermittent pneumatic compression for treatment of upper extremity vascular ulcers. IPC pump therapy can improve ulcer healing in upper and lower extremity ischemic ulcerations; 25 of 26 patients reported an improvement in wound pain with pump use. PubMed. Angiology. 2005 Jul-Aug;56(4):417-22. (Also see: Digital Ulcers) |
| Iontophoresis |
| Possible therapeutic use of vasodilator iontophoresis. Iontophoresis of the whole finger administers drugs locally with no systemic effects and warrants further investigation as a therapy. PubMed. Microvasc Res. 2005 Jan;69(1-2):89-94. |
| Quinapril: Warning, Do Not Use |
| Study warns against use of quinapril to treat digital ulcers in cutaneous sclerosis patients. The study concludes that based on these results, the routine use of ACE inhibition in treating upper-limb digital ulcers or other vascular manifestations in patients with systemic sclerosis is not advisable. Dermatology Times E-News. 01/03/08. (Also see: Quinapril for Scleroderma) |
| Prevention of vascular damage in scleroderma and autoimmune Raynaud's phenomenon: A multicenter, randomized, double-blind, placebo-controlled trial of the angiotensin-converting enzyme inhibitor quinapril. Administration of quinapril for up to 3 years had no demonstrable effects on the occurrence of upper limb digital ulcers or on other vascular manifestations of lcSSc in this patient population. PubMed. Arthritis Rheum. 2007 Oct 29;56(11):3837-3846. (Also see: Raynaud's) |
| Recombinant Human Basic Fibroblast Growth Factor (rhbFGF) |
| Basic fibroblast growth factor treatment for skin ulcerations in scleroderma. We report the use of topical application of recombinant human basic fibroblast growth factor (rhbFGF) to successfully treat therapy-resistant, chronic leg ulcers in scleroderma. PubMed. Cutis. 2005 Dec;76(6):373-6. |
| Statins |
| Statins: Potentially Useful in Therapy of Systemic Sclerosis-related Raynaud's Phenomenon (RP) and Digital Ulcers (DU) . Our results showed that statins retarded vascular injury and improved patient function. The findings suggest that statins may aid in treating RP and DU in SSc patients. A. Abou-Raya. Journal of Rheumatology. August 15, 2008. (Also see: Raynaud's and Statins) |
| Stem Cells, Topical Application for Scleroderma Digital Ulcers |
| Local implantation of autologous mononuclear cells (MNCs) from bone marrow and peripheral blood for treatment of ischaemic digits in patients with connective tissue diseases. Implantation of autologous MNCs from peripheral and bone marrow into the ischaemic digits was very effective in pain-relief and more clinical trials would be warranted to see whether this could be a new treatment modality for angiogenesis in connective tissue diseases as in Buerger's disease. PubMed. Rheumatology (Oxford). 2007 Feb 19. (Also see: Stem Cell Transplants) |
| Topical Application of Autologous Bone Marrow-Derived Cultured Mesenchymal Stem Cells to Scleroderma Ulcers. Novel techniques have been developed for culturing and delivering autologous bone marrow-derived mesenchymal stem cells to scleroderma ulcers. The phenotype of these cells has been characterized both in vitro and in vivo. The outcome seems very promising. Vincent Falanga. 1138/397 ACR 2006. (Also see: Stem Cell Transplants) |
| Stem Cells Transplant |
| Autologous stem cell transplantation improves microcirculation in systemic sclerosis. These results indicate that HSCT with high dose CYC regimen may foster vascular remodelling while CYC at lower doses and with a chronic regimen does not influence the microvasculature. Ann Rheum Dis. Published Online First: 28 February 2008. |
| Surgery: Digital Sympathectomy |
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| Wound healing after hand surgery in patients with systemic sclerosis-a retrospective analysis of 41 operations in 19 patients. In systemic sclerosis, surgery performed electively does not seem to have increased difficulty with wound healing. Even larger operations, such as wrist arthrodesis or wrist replacement, can be performed safely. PubMed. J Hand Surg [Br]. 2007 Feb 1. (Also see: Raynaud's Treatments) |
| A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia. We found that 14% of all patients required amputation and 18% of patients had ulcer recurrence. Some type of postoperative complication was reported in 37% of patients with systemic sclerosis. PubMed. J Rheumatol. 2003 Aug;30(8):1788-92. |
| Periarterial Sympathectomy as a Salvage Procedure for Refractory Digital Ischemia in Scleroderma Patients. Periarterial Sympathectomy is an effective salvage procedure in scleroderma patients with refractory digital ischemia and fingertip ulcerations. The procedure should be considered in patients who fail medical management. Nadera J. Sweiss. ACR Conference Oct. 2003. (Also see: Raynaud's) |
| Continuous regional anesthesia before surgical peripheral sympathectomy in a patient with severe digital necrosis associated with Raynaud's phenomenon and scleroderma. Continuous ambulatory regional anesthesia appears effective as a treatment bridge for vasospasm and ischemia associated with secondary Raynaud's phenomenon. PubMed. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):354-8. (Also see: Raynaud's Treatments) |
| Treprostinil (Remodulin) |
| A pilot trial of treprostinil for the treatment and prevention of digital ulcers in patients with systemic sclerosis. Of the 5 patients completing therapy, ulcer size significantly decreased and no new ulcers occurred on continuous therapy. PubMed. J Am Acad Dermatol. 2006 May;54(5):880-882. |
| Treprostinil for the treatment of severe digital necrosis in systemic sclerosis. We report a case of severe digital ulcerations associated with systemic sclerosis, successfully treated with treprostinil (Remodulin). There was improvement within days of the treatment initiation; complete healing was accomplished after 16 weeks of therapy. PubMed. Vasc Med. 2005 Feb;10(1):29-32. |
| Viagra (Sildenafil) |
| Fast and efficient healing of scleroderma-associated acral ulcers with sildenafil. This case demonstrates the efficacy of sildenafil in the treatment of scleroderma-associated refractory acral ulcers. PubMed (Hautarzt) 2007 Jul 22. (Also see: Pulmonary Hypertension) |
| Severe refractory fingertip ulcerations in a patient with scleroderma: successful treatment with sildenafil. Reduced nitric oxide levels have been proposed to play a role in the pathogenesis of vascular disease in scleroderma, and therefore sildenafil (which increases nitric oxide levels) is an attractive therapeutic prospect. PubMed. J Rheumatol. 2005 Dec;32(12):2440-2. |
| Sildenafil (Viagra) in the Treatment of Scleroderma. Sildenafil is a new option in the treatment of digital ulcers in scleroderma. Its major advantage compared with prostaglandin analogues is the oral route of administration. Controlled clinical trials should be performed. D. A. Schoeffel. AB0325 EULAR 2003. |
| Wound Care Product Index |
| Wound Care Product and Category Index The Wound Care Information Network by Dr. Allan Freedline |
| Raynaud's Prevention and Treatment |
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| Media Stories |
| Understanding How Temperature Regulation Occurs. Experiments involving 11 young men and women showed that NK-1 receptors contribute to active vasodilation [the rise in skin blood flow] and that a combined NK-1 receptor desensitization and nitric oxide inhibition further diminishes active vasodilation. Medical News Today. 10/28/06. (Also see: Raynaud's Treatments) |
| Leeches, maggots and parasitic worms can play healing role. Leeches are back into good repute as an accepted treatment for circulatory difficulties in the microsurgical reattachment of skin or body parts. Maggots, are used to remove or "debride" dead tissue in a process called "maggot debridement therapy". 72 percent of patients with autoimmune inflammatory bowel diseases who downed a Gatorade cocktail containing parasitic-worm eggs found symptoms relieved within three months. The Seattle Times 08/04/04. (Also see: Bowel Involvement and Gangrene) |
| Stories |
| Allen's Mom: Son has Scleroderma With his tightness of skin he has a very hard time bending, walking up the stairs and for the most part he cannot walk for more than a few minutes without his legs giving out... |
| Christene: Limited Scleroderma I was diagnosed when I was just nineteen and at that time it was one of the scariest moments of my life... |
| Denise E: Diffuse Scleroderma I was first diagnosed with diffuse scleroderma in February 2002, but my symptoms began subtly in the summer of 2000... |
| D.M. Hoffe: Progressive Systemic Sclerosis (Scleroderma CREST) After an endoscopy it was discovered I had a Watermelon Stomach... |
| Doni: CREST Syndrome The doctors were always interested like, "Wow look at this," but since I had no insurance, they would not touch me... |
| Donna M: CREST Scleroderma It all started with an infection at the end of my index finger in December 1999. My finger became red, inflamed and sore to touch... |
| Dorothy: Scleroderma CREST For
this reason I convened a support group in South Africa to help encourage
many others with scleroderma... |
| Elizabeth G: Diffuse Scleroderma I was fired from my job since I cannot work as I used to... |
| Kathy GR: Scleroderma Patient The doctor who had been doing the nerve blocks had told me I had scleroderma, but never mentioned that I needed to see a rheumatologist... |
| Kym: Diffuse, CREST Scleroderma, Lupus and Fibromyalgia It all started with Raynaud's in my fingers and toes when I was about nineteen years old, in 1979... |
| Leslie R: Scleroderma, Vitiligo, Lupus, Anemia, Hypertension and Type 2 Diabetes He told me that I have scleroderma and explained what this disease is about. After suffering so long I finally got some answers... |
| Lynn F: Raynaud's and Scleroderma So on November 11th my finger was amputated just above the top knuckle. Unfortunately, an infection set in... |
| Mariposa: Progressive Systemic Sclerosis I have finger ulcers, also a second degree esophagitis, but I should say that about a year ago it started receding thanks to the doctors that follow my case... |
| Michelle T: Surviving Daughter of Systemic Sclerosis Patient In memory of my mother, who was my best friend, my strength, my drive, and my compassion, I am compelled every day of my life to educate others of this disease... |
| Myrianisa: Daughter of a Severe Scleroderma Patient My mother was diagnosed with scleroderma six years ago. At the same time, she was also diagnosed with lupus, Raynaud's, MCTD, pulmonary fibrosis and fibromyalgia... |
| Nathalie: Lupus/Scleroderma I arrived at the hospital with two black fingers. They had gangrene and I was very worried about having an amputation... |
| Rose M: CREST Syndrome I was finally correctly diagnosed with CREST after two years of thinking I was going crazy... |
| Rosemary F: Surviving Daughter of Diffuse Scleroderma Patient She tried to explain it, but it was hard for me to comprehend the disease's symptoms. Mom said that it was the same thing that her oldest sister died from... |
| Rosie: Limited Systemic Sclerosis (Australia) Some of my symptoms may not be due to limited scleroderma, however most of these symptoms have appeared since my diagnosis... |
| Sheila: CREST with Limited Scleroderma I felt really scared, confused, and dehumanized in the process of my diagnosis... |
| Sue D: Diffuse Scleroderma Pain developed in my hands, then I noticed pain in my knees, then my shoulders, down my back, elbows, hips, feet... |
| Star S: Morphea and Systemic Scleroderma I was diagnosed with morphea at age seven. Now at age thirty-three, I have recently developed systemic scleroderma with gastrointestinal manifestations, Sjogren's syndrome, inflammatory arthritis, malabsorption... |
| Susie: CREST Syndrome I have had CREST syndrome for the past eight years. My specialist is Dr. Frederick Wigley, from Johns Hopkins... |
| Susie L: Raynaud's (and Scleroderma, too?) I have been told that I "probably" have scleroderma in the early stages by one doctor, that it is unlikely by another, and that I almost certainly do have it by yet another... |
| Tata P: Diffuse Scleroderma I am thirty-two years old, and I have been suffering this illness since I was nine... |
| (Español/Spanish) Tata P: Esclerodermia Difusa Hola, tengo 32 años, y padezco esta enfermedad desde los 9... |
| Teresa: Scleroderma I was just diagnosed a few hours ago. Tears are streaming down my face... |
| Yolima: Diffuse Scleroderma I was misdiagnosed for more than a year with so many diseases and given all types of medication for different problems except for the real disease... |
