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Currently there are no FDA-approved medications for the treatment of digital ulcerations in the United States. Digital ulcers are a common, unfortunate and difficult to manage consequence of the vascular obliteration and fibrosis that accompanies systemic sclerosis.
Drs. Abraham and Steen from the Georgetown University Hospital review the clinical evidence for managing Raynaud's phenomenon and digital ulcers. While Raynaud's is seen in nearly all SS patients, digital ulcers are seen in up to 30%, and its incidence may be decreasing. Aside from avoidance of cold and smoking, medications that promote vasoconstriction should be avoided (including beta blockers, migraine medicines sumatriptan and ergotamine, birth control pills and amphetamines). This review details the benefits and use of calcium channel blockers, phosphodiesterase inhibitors, sildenafil, vardenafil, tadalafil, prostacyclin analogues, bosentan, nitrates, N-acetylcysteine, ACE inhibitors, ASA, wound care, sympathectomy, botulinum toxin, autologous fat grafting and surgery.