Research on Digital Ulcers in Systemic Sclerosis (SSc, Scleroderma)

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer


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

Photo of Finger UlcerMost 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.

Should all digital ulcers (DUs) be included in future clinical trials of systemic sclerosis (SSc)–related digital vasculopathy? We would encourage the expert SSc community to reconsider the rationale for including only fingertip DUs in future SSc clinical trials, and suggest an agenda for future research. PubMed, Med Hypotheses, 2018 Jul;116:101-104.

In systemic sclerosis skin perfusion of hands is reduced and may predict the occurrence of new digital ulcers (DUs). Laser Doppler perfusion imaging indices could be used in association to the capillaroscopic and clinical findings or serological tests in the identification of patients at high risk of developing DUs. PubMed, Microvasc Res, 2017 Mar;110:1-4.

Effect of Macitentan on the Development of New Ischemic Digital Ulcers in Patients With Systemic Sclerosis: DUAL-1 and DUAL-2 Randomized Clinical Trials. Among patients with systemic sclerosis and active ischemic digital ulcers, treatment with macitentan did not reduce new digital ulcers over 16 weeks. PubMed, JAMA, 2016 May 10;315(18):1975-88.

Elucidating the burden of recurrent and chronic digital ulcers (DU) in systemic sclerosis (SSc): long-term results from the DUO Registry. SSc-associated DUs based on the occurrence of DUs over time may help to identify patients in the clinic with a heavier DU burden who could benefit from more complex management to improve their functioning and quality of life. Ann Rheum Dis, 11/26/2015.

Elevated levels of pentraxin 3 (PTX3) in systemic sclerosis (SSc): associations with vascular manifestations and defective vasculogenesis. In SSc patients, exposure to high concentrations of PTX3 may suppress EPC–mediated vasculogenesis and promote vascular manifestations such as digital ulcers and pulmonary arterial hypertension. PubMed, Arthritis Rheumatol, 2015 Feb;67(2):498-507. (Also see Pulmonary Hypertension Research)

The association of antiphospholipid antibodies (APLA) with cardiopulmonary manifestations of systemic sclerosis. APLA is associated with pulmonary arterial hypertension (PH), interstitial lung disease, Raynaud's phenomenon and digital ulcers, so endothelial abnormalities and small vessel thrombosis may be important in the pathogenesis of these disease features. PubMed, Clin Exp Rheumatol. (Also see Antiphospholipid Syndrome, Causes of Pulmonary Hypertension, and Raynaud's)

Pills by Janet Paulmenn, ISN ArtistMacitentan 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.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). 12/18/12. (Also see Scleroderma Clinical Trials)

Stress dramatically slows wound healing!

Stress-related changes to immune cells in the skin prior to wounding may impair subsequent healing. These studies show the first preliminary evidence that the number and activation of immune cells in the skin prior to wounding are affected by stress and can impact healing. PubMed, Brain Behav Immun, 2015 Nov;50:47-51. (Also see Emotional Adjustment)

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