Scleroderma is an inflammatory disease in which the immune system mistakenly attacks healthy connective tissue. This causes scar tissue to form, resulting in the stiffening of different tissues and organs including blood vessels.
In the lungs, this can lead to pulmonary arterial hypertension, and in the hands and feet, it can cause Raynaud’s phenomenon, in which blood flow to the digits — fingers and toes — is reduced, especially when exposed to cold temperatures. This reduction in blood flow can cause the formation of digital sores or ulcers. About 40 percent of scleroderma patients develop digital ulcers.
What are digital ulcers?
Digital ulcers are small sores that form on the fingers and toes as a result of a lack of blood flow. These ulcers are more prone to infection and are slow to heal due to poor blood circulation. In severe cases, surgery may be required to remove the infected regions.
Prevention of digital ulcers
The best treatment for digital ulcers is to prevent their formation in the first place. It is important to avoid alcohol, nicotine, and caffeine because these all constrict blood vessels. Limiting exposure to cold temperatures and using mittens and gloves to protect the hands can also help. Avoiding or limiting activities that can damage fingertips or blood vessels, such as typing or operating vibrating power tools, is also important.
Treatment of digital ulcers
Dressing the digital ulcers properly can help them heal and prevent redamaging the tissue. Many topical treatments are now available, and patients should speak to their nursing team to figure out what is best for them. If ulcers are infected, an antibiotic will be prescribed. Pain medications may also be prescribed since digital ulcers can be quite painful.
Vitamin C helps the body repair blood vessels, and vitamin E can help support and nourish the skin. Natural plant oils, such as linseed, flaxseed, starflower, and evening primrose oil, can help support healthy circulation.
Vasodilators, such as losartan, diltiazem, nifedipine, and iloprost, may be prescribed to treat Raynaud’s or digital ulcers. If the patient is already using one or more of these medications, the dosage or combination may need to be changed to manage digital ulcers.
Extracorporeal shock wave therapy uses a handheld device to generate ultrasound waves that can stimulate tissue growth, and may be used to treat scleroderma-associated digital ulcers.
Hyperbaric oxygen treatment, in which the patient enters a chamber with a higher than normal concentration of oxygen, can also help treat digital ulcers. This treatment has been effective in treating digital ulcers associated with diabetes.
Low-level light therapy is an experimental treatment recently reported in the Journal of Dermatological Treatment, in which infrared, red, and violet light is used to improve blood flow to the digits. While still preliminary, the data seems to indicate that the therapy is well-tolerated and may be effective in treating digital ulcers.
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