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.

Defining skin ulcers in systemic sclerosis (SSc): systematic literature review (SLR) and proposed World Scleroderma Foundation (WSF) definition. Using an SLR and a nominal technique, we developed a preliminary consensus–based definition of SSc skin ulcers. Face validity, feasibility and reliability were demonstrated for the developed definition. Journal of Scleroderma and Related Disorders, JSRD 2017; 2(2): 115 - 120.

Digital Ulcers: A Sentinel Sign

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)

The critical need for accurately defining digital ulcers in scleroderma. The high unmet need for a standardized method of defining digital ulcers is a major challenge not only for treatment, but also for development of new therapies. Journal of Scleroderma and Related Disorders, JSRD 2017; 2(2): 69 - 71.

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.

Digital ulcers (DUs) as a sentinel sign for early internal organ involvement in very early systemic sclerosis (VEDOSS). Digital ulcers significantly correlate with gastrointestinal involvement and they may be a sentinel sign for early organ involvement. PubMed, Rheumatology (Oxford), 2014 Jul 26.

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
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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