Digital Ulcers in Systemic Sclerosis - How to Manage in 2013?

Area of Science:

• Rheumatology
• Vascular Medicine
• Dermatology

Background:

• Digital ulcers (DUs) are common, disabling vascular complications in systemic sclerosis (SSc).
• The development of DUs is influenced by lesion localization, with distinct etiologies and pathogenetic mechanisms.
• Understanding these factors is crucial for guiding effective therapeutic decisions.

Purpose of the Study:

• To review the diverse etiologies and pathogenetic mechanisms of digital ulcers in systemic sclerosis.
• To outline appropriate therapeutic strategies based on the underlying causes of DUs.
• To discuss current and emerging treatment options for DUs in SSc patients.

Main Methods:

• Review of current literature on the pathogenesis and treatment of digital ulcers in systemic sclerosis.
• Analysis of factors contributing to DU development, including ischemia, fibrosis, and mechanical stress.
• Synthesis of evidence regarding pharmacological and non-pharmacological interventions.

Main Results:

• Fingertip DUs primarily result from ischemia due to SSc-related vasculopathy.
• DUs over bony prominences or calcinosis areas are linked to skin fibrosis, thinning, and mechanical friction.
• Treatment approaches vary, including vasodilators, antiplatelet agents, anticoagulants, and local care, tailored to DU etiology.

Conclusions:

• Therapeutic decisions for SSc-related digital ulcers must be guided by specific etiologic and pathogenetic factors.
• While evidence from controlled trials is limited for some agents, vasodilators, antiplatelet drugs, and anticoagulants are frequently employed.
• EUSTAR recommendations include CCBs, prostanoids, and endothelin receptor antagonists, with ongoing research into other routinely used treatments.