Therapeutic options for digital ulcers in patients with systemic sclerosis

Digital ulcers (DU) affect up to half of all patients with systemic sclerosis at some point during their disease. These lesions are extremely painful, heal slowly, and lead to substantial disability. DU arise from recurrent ischemic injury and microtrauma. Treatments for DU include non-pharmacologic modalities such as avoiding cold,stress,and trauma,as well as smoking cessation. Possible pharmacologic therapies for the prevention of DU include vasodilating agents to treat Raynaud phenomenon, statins, and oral agents used in the treatment of pulmonary hypertension (endothelin receptor antagonists, phosphodiesterase-5 inhibitors). The treatment of existing DU includes hydrocolloid occlusion, wound care, pain control, antibiotics, and the use of vasodilating medications. Intravenous or subcutaneous prostacyclins and digital or cervical sympathectomy should be considered for severe cases.