Digital (Finger or Toe) Ulcers in Systemic Sclerosis

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Sentinal Sign
-- Surgical
-- Topical
Digital Ulcer Stories
Prevention & Treatment
Raynaud's Stories


Photo of Finger UlcerSystemic scleroderma and Raynaud's can cause painful ulcers on the fingers or toes, which are known as digital ulcers. (Also see Raynaud's, What is Scleroderma? and Types of Scleroderma)

Most people try several methods of dealing with finger ulcers before settling on the system that works best for them.

But remember, no treatment for finger ulcers should be undertaken without the supervision of a physician — it's very important to treat finger ulcers properly, to prevent complications such as serious infection, gangrene or possible amputation.

Digital Ulcers: A Sentinel Sign

Peripheral blood eosinophilia is associated with the presence of skin ulcers in patients with systemic sclerosis (SSc). These results suggest that eosinophils are involved in the pathogenesis of vascular dysfunction of SSc. PubMed, J Dermatol, 02/04/2019. (Also see Antibodies)

Serum level of endostatin and digital ulcers (DU) in systemic sclerosis (SSc) patients. Serum levels of endostatin are higher in SSc patients with DUs, especially in those with infected DUs. PubMed, Int Wound J, 03/30/2018.

Ultrasound (US) characterization of cutaneous ulcers in systemic sclerosis (SSc). US may support the assessment of morphology and extent of skin ulcers in SSc and can be a helpful tool for detecting underlying pathology. PubMed, Clin Rheumatol, 03/10/2018.

Defining a unified vascular phenotype in systemic sclerosis. The more recent biomarker longitudinal studies support the concept of generalized vasculopathy and a potential association between various cardiovascular complications. PubMed, Arthritis Rheumatol, 11/16/2017. (Also see Vascular Involvement)

Risk of Digital Vascular Events in Scleroderma Patients Who Have Both Anticentromere and Anti-Interferon-Inducible Protein 16 Antibodies. Scleroderma patients who are double–positive for antibodies recognizing CENP and IFI-16 are significantly more likely to have significant digital vascular events during the course of their disease. PubMed, Arthritis Care Res (Hoboken), 2017 Jun;69(6):922-926. (Also see Antibodies and Vascular Involvement)

Vitamin D deficiency is associated with digital ulcer (DU) but not with atherosclerosis or arterial stiffness in patients with systemic sclerosis: a pilot study. Vitamin D deficiency was associated with DUs, but not with atherosclerosis or arterial stiffness, potentially indicating that vitamin D may have different effects on the microvascular and macrovascular involvement in SSc pathophysiology. PubMed, Clin Rheumatol, 2017 Jun;36(6):1325-1333. (Also see Vitamin D and Cardiac (Heart) Involvement)

Clinical relevance of antiphospholipid antibodies in systemic sclerosis (SSc): A systematic review and meta–analysis. A strong relationship exists between aCL and aß2GPI of IgG/IgM isotype and SSc; patients positive for these antibodies are more likely to suffer from pulmonary hypertension, Raynaud's, thrombosis, and digital ulcers. PubMed, Semin Arthritis Rheum, 2017 Apr;46(5):615-624. (Also see Antiphospholipid Syndrome, Raynaud's and Causes of Pulmonary Hypertension)

Calcinosis is associated with digital ischaemia in systemic sclerosis (SSc) – a longitudinal study. Ischaemia may play a role in the development of calcinosis in SSc. PubMed, Rheumatology (Oxford), 09/04/2016. (Also see Calcinosis)

Impaired angiogenesis as a feature of digital ulcers (DU) in systemic sclerosis. Our study confirmed the relationship between angiogenic vascular biomarkers and the occurrence of DU. PubMed, Clin Rheumatol, 02/26/2016.

Does the clinical context improve the reliability of rheumatologists grading digital ulcers (DU) in systemic sclerosis? The overall intra and inter–rater reliability of DU grading did not significantly improve with the clinical context and agreement between patients and rheumatologists was poor. PubMed, Arthritis Care Res (Hoboken), 01/08/2016.

Autoantibodies against Endothelin 1 Type A Receptor Are Strong Predictors of Digital Ulcers (DU) in Systemic Sclerosis (SSc). Anti–ETAR autoantibodies can be used together with the presence of current or past DU to identify patients with SSc who are at risk for the development of subsequent DU. PubMed, 08/01/2015.

Digital ulcers (DUs) predict a worse disease course in patients with systemic sclerosis (SSc). In patients with SSc, a history of DUs at presentation predicts the occurrence of DUs at follow-up and is associated with cardiovascular worsening and decreased survival. PubMed, Ann Rheum Dis, 02/16/2015.

Capillaroscopy for Digital Ulcer Risk in Systemic Sclerosis

Nailfold videocapillaroscopy can be used to assess the digital ulcer risk in people who have systemic sclerosis (SSc, scleroderma) and are also useful for diagnosis of systemic scleroderma. ISN.

Photos of Digital Ulcers

Finger UlcerPhotos of Digital Ulcers from the International Scleroderma Network (ISN) Photo Repository. ISN.


Rayanud'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.

Clinical Trials
Endothelin Rec. Antagonist
Extracorporeal Shock Wave Therapy
Hyperbaric Oxygen
Low Level Light Therapy
Quinapril (Do Not Use!)
Stem Cells
Stem Cell Transplant
Topical Solutions and Creams
Treprostinil (Remodulin)
Viagra (Sildenafil)
Wound Care Clinics

Raynaud's Prevention

Raynaud's Prevention. Reduce your exposure to cold and stress. To ty stay warm, wear gloves, and keep your core temperature up. Wear layers of clothing and thermal underwear. Avoid caffeine and vasoconstricting medications. Use shoulder bags, backpacks or trolleys. ISN.

Video Overview
Avoid Alcohol

Avoid Bad Vibrations
Avoid Cold
Avoid Pressure
Avoid Smoking
Avoid Stress
Avoid Vasocontrictors (Caffeine, Cocaine, Marijuana, Nicotine)

Research on Digital Ulcers in Systemic Sclerosis

Research on Digital Ulcers in Systemic Sclerosis. Remember, no treatment for finger ulcers should be undertaken without the supervision of a physician — it's very important to treat finger ulcers properly, to prevent complications such as serious infection, gangrene or possible amputation. ISN.

Personal Stories of Digital (Finger or Toe) Ulcers in Scleroderma Patients

Allen's Mom: Son has Scleroderma With his tightness of skin he has a very hard time bending, walking up the stairs and for the most part he cannot walk for more than a few minutes without his legs giving out…

Angel G: Systemic Scleroderma with Raynaud's Phenomenon I noticed that the middle finger on my right hand had turned so dark in color that it was practically black and I actually thought there was ink on it and tried to wash it off. Oh, if only the remedy had been so easy…

Bren: CREST Scleroderma I had three ulcers on my hands from Raynaud's. I had Botox injections for them, and by the next day they were gone…

Read more personal story listings of digital ulcers

Go to Digital Ulcer Treatments

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