Skin Ulcers and Scleroderma

For people with scleroderma, skin ulcers most often appear at the tips of fingers (digital ulcers). Skin ulcers may also extend under the fingernails, or to the joints at pressure points like elbows when the skin is stretched too tight. Scleroderma skin ulcers may also occur on the legs or other parts of the body following minor trauma such as a bruise. These sores may be very painful and can make it difficult to use your hands or other parts of your body.

Secondary Raynaud’s phenomenon is closely associated with digital ulcers in scleroderma due to the constriction of blood vessels. In primary Raynaud’s, vessels narrow and then return to their normal size. However, in scleroderma where Raynaud’s is secondary, the skin’s tiny blood vessels become increasingly smaller, sometimes disappearing entirely over time. Both Raynaud’s and digital ulcers occur in scleroderma because of narrowed blood vessels.

Blood vessels lose the ability to return to their normal size between attacks, which leads to a reduced supply of oxygen and nutrients to the skin. This can result in dry, cracked skin and the formation of small ulcers on the fingers or thumbs. In severe cases, gangrene may develop.

Skin ulcers occur in about 50% of those with limited or diffuse scleroderma. Patients with repeated episodes of Raynaud’s phenomenon are also at risk for ulcers on the fingers or toes.

How Can I Prevent Skin Ulcers in Scleroderma?

• Avoid stress and cold
• Keep as warm as possible
• Wear layers of clothing
• Wear hats in cold weather
• Wear shoes and socks that provide room for circulation
• Use Band-Aids

Treatments for Skin Ulcers:

Basic wound care and over-the-counter (OTC) medications may help with healing and pain management. Medications for skin ulcers in scleroderma may also be recommended. These include:

• Calcium channel blockers
• Endothelin receptor blockers

More serious cases of skin ulcers may require wound care, treatment of infections, and medication to improve blood flow. If the tissue is too damaged to heal, your doctor may recommend surgery or amputation might be needed.