Image type: Scleroderma digital pits
Body site: Finger, digital pits (tiny, indented areas in the fingertips that are typical of scleroderma)
Description: Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. A variety of organ systems may be involved in scleroderma. Skin changes are the hallmark of this disease in most patients. Skin thickening is most noticeable in the hands, which in early stages may appear swollen or puffy. Digital pits or scarring of distal digital pulp is characteristic. Some patients may have open ulcerations. Digital pitting is a common clinical feature in patients with progressive systemic sclerosis. Its pathogenesis is unclear, but it may result in small ulcerations. The clinical and histological features of these lesions are poorly understood.
Causes: Scleroderma affects the blood vessels, leading to reduced blood flow and oxygen supply to the fingertips. This results in tissue damage and the formation of pits. The thickening and hardening of the skin (sclerosis) reduce skin elasticity and integrity, making it more susceptible to damage and ulceration. Scleroderma is an autoimmune disease in which the immune system attacks the body’s tissues, contributing to inflammation and damage to blood vessels and skin.
Diagnosis: Diagnosing scleroderma can be challenging due to its varied forms and the different areas of the body it can affect. Physicians look for characteristic signs such as skin thickening, Raynaud’s phenomenon (spasm of blood vessels in response to cold or stress), and digital pits. Nailfold capillaroscopy, a technique that examines the capillaries at the base of the fingernail under a microscope, is used to identify abnormalities typical of scleroderma. Blood tests for specific autoantibodies (e.g., antinuclear antibodies, anti-Scl-70, anti-centromere antibodies) further help confirm the diagnosis. Additionally, Doppler ultrasound or other imaging techniques can assess blood flow and detect vascular abnormalities in the fingers.
Treatment: Because scleroderma can affect various parts of the body, treatment varies based on symptoms. Vasodilators like nifedipine and sildenafil improve blood flow and reduce Raynaud’s attacks. Anti-inflammatory and immunosuppressive agents, such as corticosteroids and methotrexate, reduce inflammation and slow disease progression. Topical antibiotics prevent or treat infections in digital pits, while wound care involves keeping pits clean and covered. Physical therapy maintains flexibility and circulation in the hands, and lifestyle changes like smoking cessation and keeping hands warm are crucial. In severe cases, surgical interventions like digital sympathectomy may improve circulation. Additional therapies include phototherapy, laser treatments, and occupational therapy. Regular monitoring and follow-up are essential for effective management.