Treatment of Ulcers In Scleroderma PDF Print E-mail
Thursday, 25 August 2011 22:11
Digital ulcers may develop in Scleroderma patients. Most systemic sclerosis patients will have digital ulcers at some point. In some, ulcers are persistent. Sometimes they progress to gangrene and amputation.

These Scleroderma ulcers are difficult to treat because of vascular disease in Scleroderma. In general, the treatment of scleroderma ulcers should be multi-faceted. It should include non-pharmacological and pharmacological measures. Antibiotics should be used judiciously. Surgical evacuation of pus is sometimes needed. Sometimes debridement is necessary.

Prevention of Scleroderma Ulcers
Ulcer prevention in patients with scleroderma is important. Once ulcers develop, treatment is difficult. Ulcer prevention involves thermal protection and prevention of trauma. Thermal protection is achieved by gloves, socks and hand and feet active warming. Cold exposure should be avoided. Good skin care is essential.

Bosentan has been shown to prevent new digital ulcer formation in patients with systemic sclerosis. It did not promote ulcer healing, though.

Mechanical treatment of scleroderma ulcers
Non-healing ulcers have been treated with Aircast™ arterial compression. These have been shown to improve ulcer healing in persons with critical limb ischemia and upper extremity ulcers.

Pharmacological treatment of scleroderma ulcers
Most patients with systemic sclerosis who develop severe Raynaud’s phenomena or digital ulcers will be offered pharmacological treatment. There are several drugs that have been suggested for the treatment of scleroderma ulcers:
  • Calcium channel antagonists – Di-hydropiridine type calcium channel antagonists have robust data in helping patients with digital ischemia. Medication such as nifedipine should be offered to these patients.
  • Bosentan – Bosentan is an endothelin receptor antagonist. It is well known from the field of pulmonary hypertension. It is recommended in the prevention of digital ulcers, as described above.
  • Sildanefil – Sildanefil is a phosphodiesterase 5 inhibitor. It has vasodilating effects. It is given in sexual dysfunction and pulmonary hypertension. Data for Sildanefil in the treatment of scleroderma ulcers is out there but is less robust. There is also data about Sildanefil and Raynaud’s phenomenon.
  • Iloprost – Iloprost is a vasodilating prostaglandin. It is administered intravenously. It has been shown to reduce the severity of ischemic attacks in patients with systemic sclerosis.

Surgical treatment of scleroderma ulcers
Surgical treatment of scleroderma ulcers involves sympathectomy. Sympathectomy can be thoracic or local, in the hand. Sympathectomy in the hand is called periarterial. It is probably useful for digital ulcers and Raynaud’s phenomena from connective tissue disease. It is probably not useful for ulcers secondary to atherosclerosis. Hand sympathectomy can be done with surgery or with botox injection.

For more on digital ulcers, read one of our previous articles here.

Source: Weinberg, I (2011), "Scleroderma Ulcers Treatment", Vascular Medicine; original article can be viewed here.


 
More articles :

» Geneticists Hunt for Scleroderma Triggers

In all its forms, gives Dartmouth geneticist Michael Whitfield, his graduate students, and his postdoctoral researchers a sense of urgency in their search for the triggers of the chronic condition. In a study that the Journal of Investigative...

» Unite Against Scleroderma A Great Success

Our very first Scleroderma Awareness Walk, "Unite Against Scleroderma" was a great success. Sunday May 1st was a dream that became a reality, simply because family and friends of the Foundation also wanted the community of Trinidad and Tobago to be...

» Georgetown Study: Scleroderma Dramatically Under-diagnosed With Commercial Screening Method

New research from Georgetown University Medical Center (GUMC) suggests that up to 40 percent of patients will not be correctly diagnosed with the disorder using a new automated commercial screening test. The findings of the study will be presented...

» Leeds Study Could Help Treat Potentially Fatal Condition

A trial of special insoles is being masterminded by Leeds-based researchers to see if they can help sufferers of a potentially fatal tissue disorder. Patients with , a rare but serious connective disorder which leads to the thickening of body...

» The Inspirational Story of Haley Pilkington

Haley Pilkington is a remarkable singer for reasons far beyond her 14 years and the dynamic voice that so effortlessly uplifts anyone who hears her sing. Haley is a student of Deborah “Zuke” Smith, a Brett Manning Associate whose students...

» Rituximab Shows Promise in Scleroderma

Rituximab (Rituxan) improved lung function in patients with , a small proof-of-principle study found.At one year, patients randomized to receive rituximab had a median 10.25% increase in forced vital capacity (FVC) compared with baseline, while...