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Treatments for Digital Ulcers in Scleroderma

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Antibiotics
Bosentan/Tracleer
Clinical Trials
Endothelin Rec. Antagonist
Extracorporeal Shock Wave Therapy
Hyperbaric Oxygen
Iloprost
N-Acetylcysteine
Quinapril (Do Not Use!)
Stem Cells
Stem Cell Transplant
Surgery
Topical Solutions and Creams
Treprostinil (Remodulin)
Viagra (Sildenafil)
Wound Care Clinics

Overview

The best treatment for digital ulcers is to prevent them from occurring in the first place. Since many digital ulcers are directly related to frequent Raynaud's episodes, it is important to follow the Raynaud's prevention techniques the help to reduce Raynaud's episodes and intensity.

It cannot be emphasized enough that scleroderma finger ulcers are not a do-it-yourself project. Do not attempt any of the ideas listed here (or elsewhere on the Internet) without consulting your doctor first. (Also see Overview of Digital Ulcers, What is Scleroderma? and Types of Scleroderma)

Study Discusses Three Therapies for Digital Ulcers in Systemic Scleroderma (SSc). Nonpharmacologic, pharmacologic, and surgical interventions are important for managing the patients who are affected by this complication. Scleroderma News, 07/01/2015.

Procedural pain management in the treatment of scleroderma digital ulcers (DU). There is valuable control of procedural pain during DU debridement with sequential, combined analgesic treatment. PubMed, Clin Exp Rheumatol, 12/22/2014.

Chronic leg ulcers in adult patients with rheumatological diseases — a 7-year retrospective review. Management of chronic leg ulcers in rheumatological patients is challenging and careful clinicopathological correlation and treatment of the underlying cause is important. PubMed, Int Wound J, 2014 Dec;11(6):601-4.

Antibiotics

Antibiotics are sometimes necessary for the treatment of infected digital ulcers.

Bosentan, Tracleer, Endothelin Receptor Antagonist (ERA)

Scleroderma Treatments: Tracleer (Bosentan). Digital ulcers in patients with systemic sclerosis (scleroderma) can be prevented and treated with Tracleer (bosentan). ISN.

Overview
Tracleer for Digital Ulcers
Tracleer for Pulmonary Fibrosis
Tracleer for Pulmonary Hypertension
Tracleer for Raynaud's
Tracleer for Scleroderma Renal Crisis
Tracleer for Skin Fibrosis
Also See

Clinical Trials for Digital Ulcers

Macitentan is also known as Opsumit by Actelion. It is a dual endothelin receptor antagonist that was submitted for FDA approval for use in pulmonary hypertension in December 2012.

Effect of Macitentan on the Development of New Ischemic Digital Ulcers in Patients With Systemic Sclerosis. Among patients with systemic sclerosis and active ischemic digital ulcers, treatment with macitentan did not reduce new digital ulcers over 16 weeks. Journal of the American Medical Association, 05/10/16.

Clinical Trial: Macitentan for the Treatment of Digital Ulcers in Systemic Sclerosis Patients (DUAL-2). The primary objective is to demonstrate the effect of macitentan on the reduction of the number of new digital ulcers in patients with systemic sclerosis and ongoing digital ulcers (DU). ClinicalTrials.gov. (Also see Digital Ulcers Research and Scleroderma Clinical Trials)

Endothelin Receptor Antagonist (ERA)

See Tracleer (Bosentan).

Extracorporeal Shock Wave Therapy

Extracorporeal shock wave therapy (ESWT) for digital ulcers associated with systemic sclerosis (SSc). The results of our study suggest that ESWT has the potential to be a novel and efficacious treatment for digital ulcers associated with SSc, and can be added to pharmacological therapy. Journal of Scleroderma and Related Disorders, JSRD 2016; 1(2): 181 - 185.

Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Improves Diabetic Ulcers Regardless of Glycemia. Hyperbaric oxygen is increasingly used as an adjunct to antibiotics, debridement, and revascularization for therapy of chronic nonhealing wounds associated with diabetes mellitus. Clinical Endocrinology News. (Also see Diabetes Research)

Iloprost

Iloprost Found To Mitigate Raynaud’s Syndrome Symptoms and Heal Associated Digital Ulcers. Iloprost is a safe and effective therapy for secondary Raynaud’s syndrome as it can ease the disease’s symptoms, improve the disability grade and heal or prevent the development of digital ulcers. Scleroderma News, 08/14/2015. (Also see Raynaud's Treatments: Medications)

Longterm Treatment with Endothelin (ET-1) Receptor Antagonist Bosentan and Iloprost (ILO) Improves Fingertip Blood Perfusion in Systemic Sclerosis (SSc). Long term treatment of SSc patients with ET-1 antagonism, in combination with ILO, seems to increase fingertip blood perfusion, as well as both capillary dilation capacity and number. PubMed, J Rheumatol, 2014 Apr 1. (Also see Bosentan)

N-Acetylcysteine

Oral N-acetylcysteine (NAC) in the treatment of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc): A randomized, double-blind, placebo-controlled clinical trial. NAC orally at a dose of 1800 mg/day showed no vasodilator effect on hands’ microcirculation after four weeks of treatment in patients with RP secondary to SSc. Revista Brasileira de Reumatologia, November–December 2014. (Also see Raynaud's Treatments)

Quinapril: Warning, Do Not Use

The routine use of ACE inhibition in treating upper-limb digital ulcers or other vascular manifestations in patients with systemic sclerosis is not advisable.

Stem Cells, Topical Application

Repeated local implantation of autologous peripheral blood mononuclear cells for the treatment of ischaemic digits in patients with connective tissue diseases Repeated implantation of peripheral blood mononuclear cells (MNCs) was effective and safe for the treatment of recalcitrant ulcers developing in ischaemic digits and toes in patients with connective tissue diseases. Rheumatology, [2010].

Stem Cell Transplant

Predictive value of vascular disease biomarkers for digital ulcers in systemic sclerosis patients. Endothelial dysfunction and angiogenic vascular biomarkers have an important role in the underlying and in the progression of microvascular disease in systemic sclerosis. PubMed, Clin Exp Rheumatol, 2015 Jul-Aug;33(4 Suppl 91):S127-30.

Cell Therapy in Patients with Critical Limb Ischemia (CLI). The results obtained from the detailed analysis of the recent literature data have confirmed the beneficial role of cell therapy in reducing the rate of major amputations in patients with CLI and improving their quality of life. PubMed, Stem Cells Int, 2015;2015:931420.

Therapeutic vascular angiogenesis for intractable macroangiopathy-related digital ulcer in patients with systemic sclerosis: a pilot study. In patients with Limited SSc, bone marrow mononuclear cell implantation provides clinical benefit and is safe, without major adverse reactions, and may become an effective strategy. PubMed, Rheumatology (Oxford), 2014 May;53(5):854

Surgery for the Treatment of Digital Ulcers in Systemic Sclerosis Patients

thumb-digital-ulcerSurgery for the Treatment of Digital Ulcers. Digital (finger, toe) ulcers can occur in patients who have either limited or diffuse systemic sclerosis (SSc), which is also known simply as scleroderma (SD) and frequently even abbreviated as "sclero". Surgical treatments include amputation of the affected area, digital sympathectomies, and peripheral arterial bypass grafts. ISN.

Overview
Amputation
Digital Sympathectomy
Peripheral Arterial Bypass
Wound Care Centers

Topical Solutions and Creams

Leg UlcerTopical treatments for digital ulcers in systemic sclerosis include calcium alginate and collagen bandages, Apligraf, Botox, Manuka or MediHoney, Betadine, Dakin's, and Silvadene. Maggot applications may even be useful, especially for large vascular foot/leg ulcers. ISN.

Overview
Botox
Creams and Solutions
Maggots
Manuka Honey/MediHoney
Spray-On Skin Cells
Wound Care Centers

Treprostinil (Remodulin), Oral and Infused by United Therapeutics

Treprostinil (Remodulin) is a treatment for pulmonary arterial hypertension which has also been studied for treating scleroderma digital ulcers. It is made by United Therapeutics. It is available as oral treprostinil and as Remodulin infusions.

Remodulin (Treprostinil Injection). Remodulin prescribing information, for pulmonary arterial hypertension. United Therapeutics. (Also see: Pulmonary Hypertension Treatments)

Oral treprostinil diethanolamine for pulmonary arterial hypertension. Emerging data suggest that in carefully selected patients oral treprostinil may be able to replace continuously infused treprostinil. PubMed, Expert Rev Clin Pharmacol, 2015 Jan;8(1):55-60.

Digital Ischemic Lesions in Scleroderma Treated With Oral Treprostinil Diethanolamine (DISTOL-1). This study will evaluate the effect of treprostinil diethanolamine (UT-15C) sustained release tablets (compared to placebo) on digital ulcers in patients with scleroderma. ClinicalTrials.gov. (Also see Digital Ulcers)

Viagra (Sildenafil)

Viagra Reveals Benefits in Treating Digital Ulcers in Systemic Sclerosis. It was concluded that sildenafil seems to have a clinical benefit in digital ulcer healing in patients with systemic sclerosis. Scleroderma News, 05/26/2015.

Wound Care

Wound Care Product and Category Index. Treatments can be looked up by type of disease, lesion, or wound. The Wound Care Information Network.

Raynaud's Treatment

Raynaud's Treatments. Mild cases of Raynaud's do not require treatment. Severe attacks which do not respond to the usual treatments, medications, and rewarming procedures may require hospitalization. ISN.

Video Overview
Mild Cases
Amputation
Biofeedback
Botox
Digital Sympathectomy
Ginkgo Biloba
Hypothyroidism
Medications
Nerve Blocks
Nitroglycerine Cream
Raynaud's Prevention
Serotonin Reuptake Inhibitors (SSRI)
Statins
Ineffective Treatments
Research & Clinical Trials
References
Go to Surgical Treatments for Digital Ulcers
 
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