From symptoms to treatment to day-to-day concerns, your scleroderma questions matter.
“Ask a Doctor” is a new Q&A column featuring responses from the SRF’s Chief Medical Officer, Dr. Gregory Gordon, offering guidance grounded in his extensive clinical expertise.
We’re kicking things off with a question about digital ulcers, a common complication of scleroderma involving painful sores that can develop on the fingers or toes due to reduced blood flow.
Q: What are some ways to help prevent digital ulcers from becoming infected?
A: A digital ulcer is a small break in the skin on the tips of the fingers or toes. Historically, about one-third of scleroderma patients have reported experiencing a digital ulcer each year, although with improved prevention and treatment, ulcers have become less common recently.
Digital ulcers are painful and at risk to become infected. The best treatment is prevention. Patients should avoid triggers. Limit exposure to cold temperatures by protecting hands and feet in winter weather, stop smoking, protect fingers from cuts or wounds, and limit substances that are known to decrease blood flow to the extremities, such as nicotine and caffeine.
Q: How does Raynaud’s in scleroderma differ from primary Raynaud’s?
A: Raynaud’s phenomenon is caused by a decrease in blood flow to the extremities, most notably the fingers. The fingers often feel numb and change to a blue or white color. As the symptoms resolve, the hands swell and turn red. Both the initial symptoms and their resolution can be very painful. In severe cases, the lack of blood flow can result in the development of ulcers on the tips or pads of the fingers.
Most people who experience Raynaud’s have “primary” disease. This means that the Raynaud’s is happening on its own and it’s the only symptom they will experience. But Raynaud’s can also be “secondary”, in which case it’s happening along with other symptoms. This can occur in people living with scleroderma and it is often the first symptom that they experience.
The main difference between “primary” and “secondary” disease is the severity of the symptoms. In primary Raynaud’s, the symptoms usually are mild, causing discoloration and pain, but resolving quickly once the inciting factors (such as cold temperate) is removed. People experiencing secondary Raynaud’s are more likely to experience more serious symptoms, such as unresolving symptoms or the development of digital ulcers. It is important to realize, though, that this is not always the case. Certainly people with primary Raynaud’s do occasionally experience severe symptoms.
Other signs that are associated with secondary Raynaud’s include involvement of the thumb, symptoms appearing later in life or experiencing additional symptoms such as muscle weakness. These are not common in primary disease.
