Universität zu Köln

Hughes, Michael ORCID: 0000-0003-3361-4909, Allanore, Yannick, El Aoufy, Khadija, Denton, Christopher P., Khanna, Dinesh, Krieg, Thomas and Matucci-Cerinic, Marco (2021). A Practical Approach to the Management of Digital Ulcers in Patients With Systemic Sclerosis A Narrative Review. JAMA Dermatol., 157 (7). S. 851 - 859. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-6084

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Abstract

IMPORTANCE Digital ulcers (DUs) occurring on the fingers in patients with systemic sclerosis (SSc) are associated with substantial pain and disability and are often challenging to treat. However, careful clinical assessment and prompt intervention (wound bed management and systemic pharmacologic treatment) may modify the clinical course. OBJECTIVES To provide a practical approach to the assessment and management of SSc-DUs and highlight unmet needs and research priorities. EVIDENCE REVIEW A narrative review of the extant literature was undertaken to provide a broad overview of current knowledge and augmented by expert opinion. FINDINGS Half of the patients with SSc have a history of DUs, and there is a point of prevalence of approximately 10%. Digital ulcers are often very painful and affect all aspects of physical, social, and family life as well as occupation. Digital ulcers are associated with a severe disease course. Systemic sclerosis DUs, particularly those occurring on the fingertips, represent a vascular ischemic complication, although other etiopathogenic factors play an important role. To guide management, a structured clinical approach is required, including DU definition, classification, and categorization. Digital ulcers require a multidisciplinary approach with close cooperation between physicians and specialist nursing and other allied health professionals to guarantee the appropriate treatment and provide patient education. Local wound bed management is necessary for all DUs and is combined with systemic (pharmacologic) treatments. When treating a DU, the clinician should actively review the therapeutic strategy to prevent further DUs, including the level of systemic disease control, and monitor closely for the development of DU complications, including infection and progression to gangrene. Despite a wide available therapeutic armory, a number of unmet needs and challenges remain that that require resolution to optimize DU management. CONCLUSIONS AND RELEVANCE A practical approach to DU management, including local wound bed management and systemic treatments, is useful. Digital ulcers are of interest to a broad range of dermatologists, rheumatologists, and other physicians providing care for patients with SSc. Careful clinical assessment and prompt intervention can substantially modify the clinical course of DUs in SSc.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hughes, Michael UNSPECIFIED orcid.org/0000-0003-3361-4909 UNSPECIFIED Allanore, Yannick UNSPECIFIED UNSPECIFIED UNSPECIFIED El Aoufy, Khadija UNSPECIFIED UNSPECIFIED UNSPECIFIED Denton, Christopher P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Khanna, Dinesh UNSPECIFIED UNSPECIFIED UNSPECIFIED Krieg, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Matucci-Cerinic, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-599124
DOI:	10.1001/jamadermatol.2021.1463
Journal or Publication Title:	JAMA Dermatol.
Volume:	157
Number:	7
Page Range:	S. 851 - 859
Date:	2021
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	2168-6084
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AUTOLOGOUS ADIPOSE-TISSUE; SPECKLE CONTRAST ANALYSIS; SCLERODERMA STUDY-GROUP; BOTULINUM-TOXIN-A; TERM-FOLLOW-UP; RAYNAUDS-PHENOMENON; DOUBLE-BLIND; PHENOMENON SECONDARY; ORGAN INVOLVEMENT; THERAPY Multiple languages Dermatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59912