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Treatments for Digital Ulcers in Scleroderma

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Antibiotics
Bosentan/Tracleer
Clinical Trials
Endothelin Rec. Antagonist
Hyperbaric Oxygen
Iloprost
N-Acetylcysteine
Quinapril (Do Not Use!)
Stem Cells
Stem Cell Transplant
Surgery
Topical Solutions and Creams
Treprostinil (Remodulin)
Viagra (Sildenafil)
Wound Care Clinics

Overview

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. (Also see Overview of Digital Ulcers, What is Scleroderma? and Types of Scleroderma)

Procedural pain management in the treatment of scleroderma digital ulcers (DU). There is valuable control of procedural pain during DU debridement with sequential, combined analgesic treatment. PubMed, Clin Exp Rheumatol, 12/22/2014.

Chronic leg ulcers in adult patients with rheumatological diseases — a 7-year retrospective review. Management of chronic leg ulcers in rheumatological patients is challenging and careful clinicopathological correlation and treatment of the underlying cause is important. PubMed, Int Wound J, 2014 Dec;11(6):601-4.

Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails—A Consensus of Systemic Sclerosis Experts. Symptoms treatment recommendations by over 100 scleroderma experts, for scleroderma renal crisis (SRC), digital ulcers (DU), pulmonary hypertension (PAH/PH), reflux, skin involvement, and arthritis. Seminars in Arthritis and Rheumatism Volume 42, Issue 1 , Pages 42-55, August 2012. (Also see Scleroderma Renal Crisis, Pulmonary Hypertension, Reflux, Skin Involvement, Skeletal Involvement, Scleroderma Treatments, and Dr. Janet Pope)

Antibiotics

Antibiotics are sometimes necessary for the treatment of infected digital ulcers.

Bosentan, Tracleer, Endothelin Receptor Antagonist (ERA)

Scleroderma Treatments: Tracleer (Bosentan). Digital ulcers in patients with systemic sclerosis (scleroderma) can be prevented and treated with Tracleer (bosentan). ISN.

Overview
Tracleer for Digital Ulcers
Tracleer for Heart Involvement in SSc
Tracleer for Pulmonary Fibrosis
Tracleer for Pulmonary Hypertension
Tracleer for Raynaud's
Tracleer for Scleroderma Renal Crisis
Tracleer for Skin Fibrosis
Also See

Clinical Trials for Digital Ulcers

Macitentan is also known as Opsumit by Actelion. It is a dual endothelin receptor antagonist that was submitted for FDA approval for use in pulmonary hypertension in December 2012.

Clinical Trial: Macitentan for the Treatment of Digital Ulcers in Systemic Sclerosis Patients (DUAL-2). The primary objective is to demonstrate the effect of macitentan on the reduction of the number of new digital ulcers in patients with systemic sclerosis and ongoing digital ulcers (DU). ClinicalTrials.gov, 12/18/12. (Also see Digital Ulcers Research and Scleroderma Clinical Trials)

Endothelin Receptor Antagonist (ERA)

See Tracleer (Bosentan).

Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Improves Diabetic Ulcers Regardless of Glycemia. Hyperbaric oxygen is increasingly used as an adjunct to antibiotics, debridement, and revascularization for therapy of chronic nonhealing wounds associated with diabetes mellitus. Clinical Endocrinology News, 2012. (Also see Diabetes Research)

Iloprost

Longterm Treatment with Endothelin (ET-1) Receptor Antagonist Bosentan and Iloprost (ILO) Improves Fingertip Blood Perfusion in Systemic Sclerosis (SSc). Long term treatment of SSc patients with ET-1 antagonism, in combination with ILO, seems to increase fingertip blood perfusion, as well as both capillary dilation capacity and number. PubMed, J Rheumatol, 2014 Apr 1. (Also see Bosentan)

N-Acetylcysteine

N-acetylcysteine (NAC) attenuates subcutaneous administration of bleomycin (BLM)-induced skin fibrosis and oxidative stress in a mouse model of scleroderma. NAC may be a potential therapeutic agent for patients with scleroderma. Clinical and Experimental Dermatology, 2013 Mar 21.

Quinapril: Warning, Do Not Use

The routine use of ACE inhibition in treating upper-limb digital ulcers or other vascular manifestations in patients with systemic sclerosis is not advisable.

Stem Cells, Topical Application

Repeated local implantation of autologous peripheral blood mononuclear cells for the treatment of ischaemic digits in patients with connective tissue diseases Repeated implantation of peripheral blood mononuclear cells (MNCs) was effective and safe for the treatment of recalcitrant ulcers developing in ischaemic digits and toes in patients with connective tissue diseases. Rheumatology, December 15, 2010.

Stem Cell Transplant

Long-Term Safety And Efficacy Of Therapeutic Angiogenesis By The Autologous Transplantation Of Bone-Marrow Derived Cells Against Intractable Skin Ulcer In Patients With Systemic Sclerosis (Ssc). Therapeutic angiogenesis by the autologous transplantation in SSc patients was found to be an effective and safe approach to intractable ulcers in long-term observational study. Ann Rheum Dis, 2011;70 (Suppl3):176.

Surgery for the Treatment of Digital Ulcers in Systemic Sclerosis Patients

thumb-digital-ulcerSurgery for the Treatment of Digital Ulcers. Digital (finger, toe) ulcers can occur in patients who have either limited or diffuse systemic sclerosis (SSc), which is also known simply as scleroderma (SD) and frequently even abbreviated as "sclero". Surgical treatments include amputation of the affected area, digital sympathectomies, and peripheral arterial bypass grafts. ISN.

Overview
Amputation
Digital Sympathectomy
Peripheral Arterial Bypass
Wound Care Centers

Topical Solutions and Creams

Leg UlcerTopical treatments for digital ulcers in systemic sclerosis include calcium alginate and collagen bandages, Apligraf, Botox, Manuka or MediHoney, Betadine, Dakin's, and Silvadene. Maggot applications may even be useful, especially for large vascular foot/leg ulcers. ISN.

Overview
Botox
Creams and Solutions
Maggots
Manuka Honey/MediHoney
Spray-On Skin Cells
Wound Care Centers

Treprostinil (Remodulin)

Remodulin is also known as treprostinil. It is made by United Therapeutics.

Remodulin: Treatment of Pulmonary Arterial Hypertension. Remodulin is a prescription medication for the treatment of pulmonary arterial hypertension (PAH) (WHO Group 1) to diminish symptoms associated with exercise. Remodulin.com, 2012.

Viagra (Sildenafil)

Bosentan and sildenafil: successful treatment in a sclerodermic patient with refractory ulcers. Treatment resulted in complete healing of old ulcers both to upper and lower limbs and allowed the interruption of intravenous therapies. Reumatisimo, 2013-05-27. (Also see Bosentan/Tracleer)

Wound Care

Wound Care Product and Category Index. The Wound Care Information Network.

Raynaud's Treatment

Raynaud's Treatments. Mild cases of Raynaud's do not require treatment. Severe attacks which do not respond to the usual treatments, medications, and rewarming procedures may require hospitalization. ISN.

Video Overview
Mild Cases
Amputation
Biofeedback
Botox
Digital Sympathectomy
Ginkgo Biloba
Hypothyroidism
Medications
Nerve Blocks
Nitroglycerine Cream
Raynaud's Prevention
Serotonin Reuptake Inhibitors (SSRI)
Statins
Ineffective Treatments
Research & Clinical Trials
References
Go to Surgical Treatments for Digital Ulcers
Copyright 1998-2015, International Scleroderma Network. AKA Scleroderma from A to Z and SCLERO.ORG. All Rights Reserved.
Copyright 1998-2015, International Scleroderma Network. AKA Scleroderma from A to Z and SCLERO.ORG. All Rights Reserved.
Copyright 1998-2015, International Scleroderma Network. AKA Scleroderma from A to Z and SCLERO.ORG. All Rights Reserved.