Scleroderma Types Systemic Symptoms Skin Ulcers

Research on Digital Ulcers in Systemic Sclerosis (SSc, Scleroderma)

Overview

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

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.

The incidence rate of pulmonary arterial hypertension (PAH) and scleroderma renal crisis (SRC) in systemic sclerosis patients with digital ulcers on endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i). Treatment with ERAs and/or PDE5i appeared to delay the occurrence of SRC. PubMed, Rheumatology (Oxford), 2020 Aug 26;keaa401. (Also see Pulmonary Hypertension and Kidney (Renal) Involvement)

Study of “Pre-Ulcer ” Stage May Inform Treatment of Digital Ulcers in Scleroderma. These findings can help develop strategies to prevent digital ulcers, such as avoiding severe cold, hand hygiene, and avoiding mechanical injury. Scleroderma News, 02/21/2020.

Is there a role for laser speckle contrast analysis (LASCA) in predicting the outcome of digital ulcers (DUs) in patients with systemic sclerosis (SSc)? This study demonstrates for the first time that the ulcer area and the finger base ratio may predict the healing time of DUs in SSc patients and may be crucial for the prognostic stratification of patients. PubMed, Clin Rheumatol, 2020 Jan;39(1):69-75.

Should all digital ulcers (DUs) be included in future clinical trials of systemic sclerosis (SSc)–related digital vasculopathy? We would encourage the expert SSc community to reconsider the rationale for including only fingertip DUs in future SSc clinical trials, and suggest an agenda for future research. PubMed, Med Hypotheses, 2018 Jul;116:101-104.

The association of antiphospholipid antibodies (APLA) with cardiopulmonary manifestations of systemic sclerosis. APLA is associated with pulmonary arterial hypertension (PH), interstitial lung disease, Raynaud's phenomenon and digital ulcers, so endothelial abnormalities and small vessel thrombosis may be important in the pathogenesis of these disease features. PubMed, Clin Exp Rheumatol. (Also see Antiphospholipid Syndrome, Causes of Pulmonary Hypertension, and Raynaud's)

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 Scleroderma Clinical Trials)

Stress dramatically slows wound healing!

Stress-related changes to immune cells in the skin prior to wounding may impair subsequent healing. These studies show the first preliminary evidence that the number and activation of immune cells in the skin prior to wounding are affected by stress and can impact healing. PubMed, Brain Behav Immun. (Also see Emotional Adjustment)

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