Skin Ulcers & Scleroderma: Complications and Treatments

What are skin ulcers?
Skin ulcers are deep wounds that go past the top layers of skin. They occur in about 40% of those with limited or diffuse scleroderma.¹ For people with scleroderma, skin ulcers most often appear at the tips of fingers and toes; these are called digital ulcers.

But scleroderma skin ulcers can occur in other locations as well

Skin ulcers can also form:

Under the fingernails
On joints at pressure points, like elbows, when the skin is stretched too tight.
On the legs or other parts of the body following minor trauma such as a bruise.

These sores may be slow to heal, be very painful, and can make it difficult to use your hands or other parts of your body.

How are Raynaud’s Phenomenon and Digital Ulcers related?

Patients with repeated episodes of Raynaud’s phenomenon are also at risk for toe or finger ulcers. In primary Raynaud’s, vessels narrow and then return to their normal size. However, in scleroderma, where Raynaud’s is secondary, the skin’s tiny blood vessels become increasingly smaller, or may become damaged over time. Sometimes they disappear entirely. Both Raynaud’s and digital ulcers occur in scleroderma because of narrowed blood vessels.

When blood vessels lose the ability to return to their normal size between attacks, this leads to a reduced supply of oxygen and nutrients to the skin. This can result in dry, cracked skin and the formation of small ulcers on the fingers or thumbs or toes. Digital ulcers may also form at areas of pressure, trauma, or where calcium deposits (calcinosis) are present. In severe cases, infection may develop.

Frequency of these ulcers is variable. These ulcers may happen from time to time (episodic), recurrent, or not be healing (chronic), and in some cases, they can lead to infection or tissue damage if left untreated.

How Can You Prevent Skin Ulcers in Scleroderma?

Avoid stress and cold
Keep as warm as possible
Wear layers of clothing
Wear hats in cold weather
Wear shoes and socks that provide room for circulation
Use Band-Aids
Protect your hands and feet from cuts, pressure, and injury

Treatments for Scleroderma Skin Ulcers

Basic wound care and over-the-counter (OTC) medications may help with healing and pain management. Medications for skin ulcers in scleroderma may also be recommended. These include:

Calcium channel blockers
Endothelin receptor blockers

More serious cases of skin ulcers may require wound care, treatment of infections, and medication to improve blood flow. If the tissue is too damaged to heal, your doctor may recommend surgery, or even amputation might be needed. Early treatment is important to help reduce pain, prevent infection, and protect healthy tissue.

Sources:

Allanore Y, Simms R, Distler O, et al., Nat Rev Dis Primers. 2015;1.doi:10.1038/nrdp.2015.

Featured Webinar

SRF Webinar on Raynaud’s and Digital Ulcers in Scleroderma

Tracy Frech, MD, MS, from Vanderbilt University, breaks down the science behind Raynaud’s phenomenon and digital ulcers in systemic sclerosis and discusses the latest treatment approaches.

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