Digital ulcer management in patients with systemic sclerosis

Introduction Digital ulcers (DUs) are a major clinical problem for patients with systemic sclerosis (SSc). Almost half of SSc patients experience at least one acral DU during the course of the disease. Patients with DUs may suffer from severe pain and often undergo a limitation of daily life activities, thus resulting in a functional impairment with a significant impact on the patient’s health-related quality of life. Prevention of further complications and lesions is possible if the initial evaluation is performed early and correctly and if a treatment is started promptly. Pharmacologic treatment is important, but it is not the only possible approach to patients with DUs. This review provides an overview of the available different treatment options for DUs together with a proposal of a diagnostic-therapeutic approach aimed at a better definition and treatment of patients with SSc and DUs. Discussion A correct approach to the patient with DUs begins with a careful examination and evaluation of risk factors and comorbidities in order to cure and prevent complications and further lesions. Then also a correct local treatment of the DU provides a better milieu to foster healing and prevent complications such as infection or gangrene. Different drugs with different mechanisms of action are to date available for the treatment and prevention of DUs in SSc, but it will be swiftly effective only if in combination with good information of the patient and a thorough local treatment of the ulcers. Conclusion A correct therapeutic approach can be based only on a correct education and information of the patient.