When Digital Ulcers Occur

Emergency Department
Digital Ulcers

While the vast majority of Raynaud’s sufferers have the less severe primary form of the condition (no underlying disease is the cause), others may experience painful sores at the extremities that are difficult to heal.  These sores are known as digital ulcers.

Unfortunately, I am one of those with severe ramifications of secondary Raynaud’s, caused—in my case—by my systemic scleroderma. I’ve suffered with painful digital ulcers since I was first diagnosed with scleroderma some 19 years ago. I wish I could advise others on how to cure these sores, but we haven’t found the solution yet. However, I have learned some techniques to help avoid and ease the pain, which I wish to share with others who suffer from these painful, hard-to-heal ulcers.

There are many medications used to address Raynaud’s that help increase blood flow to the extremities. Yes, they may help somewhat, but for those like me, they do not allow blood to flow adequately to the tissues — and ulcers may develop. Digital ulcers can be extremely painful and difficult to eradicate. They may improve but then recur. In the most extreme cases of secondary Raynaud’s, tissue may die (necrosis), and amputation may be necessary. That is why consulting with your doctor is key in your care plan, especially if your ulcer may appear inflamed, infected and in need of medication.

Protection, cleaning and moisturizing are crucial elements to address pain and infection and to ensure the proper healing environment when ulcers occur. When protecting an ulcer, there are many options. Commercial Band Aids® and bandages are widely available. Different sizes allow for protection of even the smallest of ulcers. There are even bandages that contain healing ointments in their padding, for example, Neosporin® or Manuka honey. Band Aids that are very cushioned work best for me. I use PolyMem® cloth strips which are more expensive than regular bandages. However, they have a large cushion area and use a non -abrasive tape which doesn’t stick to the wound or surrounding tissue so dressing changes are less painful and trauma to the wound is minimized. 

Some ulcers may seem like they are healing well without being covered. Regardless, protection of the ulcer from infection, opening up again, trauma and in some cases helping to keep the ulcer warm should be in your care plan.  

For all types of digital ulcers, keeping them clean and moisturized should also be included in your care plan. There are many ways to clean an ulcer. For example: using a warm salt water rinse like saline, or warm water soaks with mild soaps, or betadine or hydrogen peroxide.  While cleansing, removing dead skin or debris may be needed to help bring new skin to the surface. I use warm saline and a sterile Q-tip® to lightly debride (remove dead tissue and debris) from my ulcers.   Doctors may prescribe certain creams or gels that help keep the wound clean and free from infection, for example Santyl or Silvadene. 

After cleansing, another step in your care plan should be to create the optimal conditions for proper healing of an ulcer. Maintaining moisture and not allowing the ulcer to get dry under a Band-Aid or bandage will help promote a good environment for healing. However, if an ulcer is wet and is secreting fluid from it, adding moisture should be discussed with your doctor. Using microbial ointments, lidocaine gels or even petroleum jelly like Vaseline® may be an option. I use a mixture of Neosporin®, lidocaine and Aquaphor® together on my ulcers.  Whatever your preference is, make it a part of your daily care plan to help your ulcer heal faster.  

I have found that the appearance of ulcers can be very misleading because they heal from the inside out. They may appear to be healed but under a scab could be a deep ulcer that may have many scabs during its healing process. That is why protection, cleaning and moisturizing are so important at every stage. Raynaud’s is painful for most all sufferers, whether it’s primary or secondary to another issue such as mine. Protecting the extremities from damage, as much as possible, can have a big impact on your ability to successfully cope with its challenges.  I hope my strategies are helpful in guiding you on how to manage through the healing process with your digital ulcers. Having a consistent care plan will help you and/or your caregivers.   

Below are links to additional articles we’ve published on digital ulcers:

Finger Ulcers: What Causes Them? What Can be Done About Them?

Raynaud’s Phenomenon & Digital Ulcers

Digital Ulcers: Treatment Options