Optimal management of digital ulcers in systemic sclerosis

Figures & data

Table 1 Therapies for RP and DUs in scleroderma

Type of therapy	References
Nonpharmacologic treatment
Smoking cessation
Avoidance of precipitants, including cold, stress, and vasoconstrictive agents such as beta blockers and amphetamines
Use of hand warmers and protective clothing
Pharmacologic treatment of RP
Calcium channel blockers	^Citation7^–^Citation9
Angiotensin receptor blockers	^Citation35
Alpha-adrenergic blockers	^Citation36
Digital ulcer treatment
Phosphodiesterase inhibitors	^Citation10^–^Citation21
Prostacyclin analogs	^Citation22^–^Citation25
Endothelin receptor antagonists	^Citation26^–^Citation28
Nitrates	^Citation29^–^Citation32
N-acetylcysteine	^Citation33, ^Citation34
Statins	^Citation38
Local management of ulcers
Intermittent wet soaks, occlusive dressings, vitamin E gel	^Citation39
Topical/systemic antibiotics for concurrent infection
Adequate pain control
Debridement as indicated
Surgical management of RP and DUs
Central sympathectomy (endoscopic thoracic sympathectomy)	^Citation41
Digital sympathectomy	^Citation42^–^Citation44
Botulinum a toxin injection	^Citation45, ^Citation46
Autologous fat grafting	^Citation47, ^Citation48
Surgical amputation

Abbreviation: DUs, digital ulcers; RP, Raynaud’s phenomenon.

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