Digital (Finger or Toe) Ulcers in Systemic Sclerosis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Sentinal Sign
-- Surgical
-- Topical
Digital Ulcer Stories
Prevention & Treatment
Raynaud's Stories


Photo of Finger UlcerSystemic scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers. (Also see Raynaud's, What is Scleroderma? and Types of Scleroderma)

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.

Digital ulcers (DUs) in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden. DUs place a large burden on the patient and healthcare system through reduced health-related quality of life and increased healthcare resource utilization and associated cost. PubMed, Arthritis Res Ther, 2019 Dec 23;21(1):299.

LAUDES Study: impact of digital ulcers (DUs) on hand functional limitation, work productivity and daily activities, in systemic sclerosis (SSc) patients. Study findings show an impaired hand function and increased disability for daily life activities and work productivity in SSc patients with DUs compared with patients without DUs in Spanish population. PubMed, Rheumatol Int, 2019 Nov;39(11):1875-1882.

Digital Ulcers: A Sentinel Sign

Vascular biomarkers and digital ulcerations in systemic sclerosis: results from a randomized controlled trial of oral treprostinil (DISTOL-1). Longitudinal assessment of vascular biomarkers in a clinical trial setting provides a unique opportunity to define biomarkers that predict vascular outcomes. PubMed, Clin Rheumatol, 2020 Apr;39(4):1199-1205. (Also see Vascular Involvement)

Peripheral blood eosinophilia is associated with the presence of skin ulcers in patients with systemic sclerosis (SSc). These results suggest that eosinophils are involved in the pathogenesis of vascular dysfunction of SSc. PubMed, J Dermatol, 02/04/2019. (Also see Antibodies)

Prevalence and Clinical Associations of Antiphospholipid Antibodies in Systemic Sclerosis: New Data From a French Cross-Sectional Study, Systematic Review, and Meta-Analysis. These data provide additional insights into the role of aPL in the vasculopathy observed in SSc. PubMed, Front Immunol, 2018 Nov 2;9:2457. (Also see Antiphospholipid Syndrome, Raynaud's and Causes of Pulmonary Hypertension)

Serum level of endostatin and digital ulcers (DU) in systemic sclerosis (SSc) patients. Serum levels of endostatin are higher in SSc patients with DUs, especially in those with infected DUs. PubMed, Int Wound J, 03/30/2018.

Ultrasound (US) characterization of cutaneous ulcers in systemic sclerosis (SSc). US may support the assessment of morphology and extent of skin ulcers in SSc and can be a helpful tool for detecting underlying pathology. PubMed, Clin Rheumatol, 03/10/2018.

Defining a unified vascular phenotype in systemic sclerosis. The more recent biomarker longitudinal studies support the concept of generalized vasculopathy and a potential association between various cardiovascular complications. PubMed, Arthritis Rheumatol, 2018 Feb;70(2):162-170. (Also see Vascular Involvement)

Capillaroscopy for Digital Ulcer Risk in Systemic Sclerosis

Nailfold videocapillaroscopy can be used to assess the digital ulcer risk in people who have systemic sclerosis (SSc, scleroderma) and are also useful for diagnosis of systemic scleroderma. ISN.

Photos of Digital Ulcers

Finger UlcerPhotos of Digital Ulcers from the International Scleroderma Network (ISN) Photo Repository. ISN.


Rayanud'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.

Clinical Trials
Endothelin Rec. Antagonist
Extracorporeal Shock Wave Therapy
Hyperbaric Oxygen
Low Level Light Therapy
Quinapril (Do Not Use!)
Stem Cells
Stem Cell Transplant
Topical Solutions and Creams
Treprostinil (Remodulin)
Viagra (Sildenafil)
Wound Care Clinics

Raynaud's Prevention

Raynaud's Prevention. Reduce your exposure to cold and stress. To ty stay warm, wear gloves, and keep your core temperature up. Wear layers of clothing and thermal underwear. Avoid caffeine and vasoconstricting medications. Use shoulder bags, backpacks or trolleys. ISN.

Video Overview
Avoid Alcohol

Avoid Bad Vibrations
Avoid Cold
Avoid Pressure
Avoid Smoking
Avoid Stress
Avoid Vasocontrictors (Caffeine, Cocaine, Marijuana, Nicotine)

Research on Digital Ulcers in Systemic Sclerosis

Research on Digital Ulcers in Systemic Sclerosis. 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. ISN.

Personal Stories of Digital (Finger or Toe) Ulcers in Scleroderma Patients

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…

Angel G: Systemic Scleroderma with Raynaud's Phenomenon I noticed that the middle finger on my right hand had turned so dark in color that it was practically black and I actually thought there was ink on it and tried to wash it off. Oh, if only the remedy had been so easy…

Bren: CREST Scleroderma I had three ulcers on my hands from Raynaud's. I had Botox injections for them, and by the next day they were gone…

Read more personal story listings of digital ulcers

Go to Digital Ulcer Treatments

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