What are digital ulcers?
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Digital ulcerations are very painful and difficult to heal open wounds, usually on fingers and toes that leave scars. The ulcers affect the patients in the exercise of their professional activities and in daily activities such as body care, food intake and shopping. Patients with systemic scleroderma have a high risk of developing digital ulcerations.
How frequent are digital ulcerations?
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44 percent of patients with systemic Scleroderma According to a study by Hachulla have a history of digital ulceration.
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30 percent of patients with persistent digital ulcerations already have tissue loss.
What causes digital ulceration?
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The digital ulcerations can be preceded by the so-called Raynaud syndrome (RS). Raynaud's syndrome occurs in 90 to 100 percent of scleroderma patients. It is often an early symptom that can occur several years before the actual diagnosis is made. The patients suffer from a seizure-related severe blood circulation reduction of the fingers after cold exposure or psychological stress with only slow, usually painful warming.
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The cause lies in a disturbed balance between vasoconstrictive and vasodilative regulatory mechanisms on the floor of an endothelial disorder. In the worst case, the pronounced vasoconstriction results in reduced blood flow to the tissue and digital ulcerations.
- Endothelin, a potent endogenous vasoconstrictor, plays a key role in the context of vasculopathies and subsequent vascular damage. The two endothelin receptors ETA and ETB are expressed in the kidney, liver, lung and skin, among others. In various diseases (e.g. scleroderma, pulmonary arterial hypertension) with Vascular damage this expression is increased. The increased endothelin release not only causes pathological vasoconstriction, but also leads to fibrosis, vascular hypertrophy and inflammation.
