z-logo
open-access-imgOpen Access
Non‐healing ischaemic digital ulcer in a systemic sclerosis patient: a challenging clinical case
Author(s) -
Blaise Sophie,
Roustit Matthieu,
Forli Alexandra,
Imbert Bernard,
Cracowski JeanLuc
Publication year - 2017
Publication title -
international wound journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.867
H-Index - 63
eISSN - 1742-481X
pISSN - 1742-4801
DOI - 10.1111/iwj.12742
Subject(s) - medicine , bosentan , iloprost , endothelin receptor antagonist , botulinum toxin , sildenafil , quality of life (healthcare) , endothelin receptor , surgery , prostacyclin , receptor , nursing
Ischaemic digital ulcers ( DUs ) are an indicator of the severity of the microangiopathy in patients with systemic sclerosis ( SSc ). DUs are a frequent complication, affecting about 50% of patients with SSc , and are often recurrent. In cross‐sectional studies involving patients with SSc , the frequency of ischaemic DUs was 12–16% with a major impact on hand function and quality of life. Effective therapy for DUs remains elusive. Intravenous iloprost has been demonstrated to have a positive effect on healing of active DUs . Bosentan, an oral endothelin receptor antagonist, only showed a benefit in preventing the occurrence of new DUs . Despite limited evidence, recent guidelines have recommended phosphodiesterase type 5 inhibitors as an option. Injection of botulinum toxin and digital sympathectomy have been increasingly used for ischaemic DUs . Here we present the complex case of a SSc patient already treated with sildenafil and bosentan in whom an active DU was successfully treated with botulinum toxin A. Despite the lack of a randomised controlled trial, results are encouraging for the use of botulinum toxin in the treatment of DUs and could perhaps help to avoid some amputations, as in the present case.

The content you want is available to Zendy users.

Already have an account? Click here to sign in.
Having issues? You can contact us here