At our August Virtual Education Session, rheumatology nurse practitioner Emma Bavage shared practical insights into managing skin involvement and digital ulcers in people living with scleroderma.
The session explored why digital ulcers develop, the different types of ulcers that can occur, and practical strategies for prevention, wound care and protecting the skin. Emma also highlighted the importance of staying warm, maintaining hand function, working with a multidisciplinary healthcare team, and knowing when to seek medical attention. The session also introduced SPIN Self, a new free self-management resource designed specifically for people living with scleroderma.
Why Do Digital Ulcers Develop in Scleroderma?
Digital ulcers can be painful and can have a significant impact on everyday activities and hand function.
Emma explained that several factors can contribute to their development, including skin fibrosis, Raynaud’s-related blood vessel narrowing, microvascular changes and reduced oxygen supply to the tissues. Digital ulcers can occur in different ways, which is why identifying the type of ulcer is important when deciding how it should be managed.
Three broad types discussed during the session were:
- Ischaemic ulcers, commonly affecting the fingertips
- Traumatic ulcers, which can develop over areas exposed to pressure or repeated trauma
- Calcinosis-related ulcers, associated with deposits of calcium beneath the skin
Each type can require a different management approach.
Prevention Starts with Protecting the Skin
Preventing an ulcer from developing in the first place is an important part of scleroderma care.
Emma highlighted several practical strategies that may help protect the skin and support circulation, including:
- Keeping hands and the body warm
- Avoiding sudden temperature changes
- Not smoking
- Managing stress where possible
- Maintaining regular physical activity
- Working with physiotherapists or exercise physiologists
- Protecting areas vulnerable to pressure or trauma
Keeping the skin moisturised is also important. Regular moisturising can help maintain the skin barrier, particularly when applied to slightly damp skin. Cotton gloves worn overnight may also help retain moisture.
For areas exposed to repeated pressure, silicone finger protectors or other protective coverings may help reduce trauma, provided they fit comfortably and do not restrict circulation.
Managing Digital Ulcers and Wound Care
When a digital ulcer develops, appropriate wound care is important to support healing, protect the surrounding skin and reduce the risk of infection.
The key goals of wound care are to:
- Support healing
- Maintain an appropriate level of moisture
- Protect the surrounding skin
- Reduce infection risk
- Maintain hand and finger function
Open ulcers should generally be protected with an appropriate dressing. Emma discussed several types of wound dressings that may be used depending on the individual wound, including antimicrobial and non-adherent options. Dressing choice should take into account effectiveness, comfort and cost.
It is also important to watch for possible signs of infection. Increasing pain, throbbing, redness or pus should prompt medical assessment rather than waiting for the wound to improve on its own.
In some situations, debridement may be used as part of wound management. More complex wounds may require assessment by other specialists, including plastic surgery.
Keeping Warm Can Help Protect Hands and Feet
For people living with scleroderma and Raynaud’s phenomenon, temperature management is an important part of everyday care.
Even small changes in temperature – including air conditioning during warmer weather – can trigger symptoms. Keeping the whole body warm, rather than focusing only on the hands, can be helpful.
The session highlighted practical options such as:
- Heated gloves
- Heated vests
- Rechargeable hand warmers
- Warm clothing
- Heated blankets when sitting for extended periods
Keeping the wrists and core warm can also help maintain circulation to the hands.
Technology may also offer new possibilities. Research at the University of Sydney is exploring gloves that can detect changes in blood flow and automatically adjust their temperature, potentially providing a more responsive approach to managing Raynaud’s symptoms in the future.
Protecting Hand Function Through Physiotherapy
Looking after the skin is only part of managing hand involvement in scleroderma.
Emma emphasised the importance of hand physiotherapy, general physiotherapy and exercise to help maintain movement, strength and function.
Hand physiotherapists and occupational therapists can help with exercises and, where appropriate, splinting to maintain hand function and reduce the risk of contractures. Regular physical activity can also support general wellbeing.
A personalised exercise program should always take individual symptoms, abilities and medical advice into account.
Calcinosis Can Require Specialist Care
Calcinosis, where calcium deposits form under the skin, can be particularly difficult to manage.
These deposits can become painful, cause repeated trauma and sometimes lead to ulcers. Emma explained that calcinosis is challenging to treat and that debridement is not automatically appropriate, particularly when the skin is closed. Open wounds may require a different approach to reduce infection risk.
Researchers are also investigating potential treatments for calcinosis, including sodium thiosulfate injections, although further research and practical considerations around treatment preparation remain.
This highlights why persistent or painful calcinosis should be assessed by a healthcare professional familiar with scleroderma.
The Importance of Multidisciplinary Care
Scleroderma can affect many aspects of a person’s health and daily life, which means care often requires more than one type of healthcare professional.
The Tasmanian multidisciplinary scleroderma clinic brings together rheumatology, nursing and physiotherapy, while Emma highlighted the importance of broader access to services such as occupational therapy, psychology and social work.
A coordinated approach can help address not only physical symptoms but also mobility, daily activities, emotional wellbeing and quality of life.
Advocating for Yourself in Healthcare
Another important message from the session was the value of patient advocacy.
People living with scleroderma often understand their symptoms and usual treatment needs extremely well. Having a clear understanding of your condition, knowing what type of ulcer you have, and communicating with your regular rheumatology team can help ensure appropriate care.
This can be particularly important when seeking treatment outside your usual specialist service. Emma highlighted the risk of scleroderma-related ulcers being mistaken for other types of wounds in emergency settings. Patients can ask healthcare professionals to consider their scleroderma history and contact their rheumatology team when specialist guidance is needed.
Introducing SPIN Self: Support for Everyday Living
The session also introduced SPIN Self, a new free online self-management program developed by the Scleroderma Patient-centered Intervention Network (SPIN).
SPIN is an international collaboration involving researchers, healthcare professionals, patient organisations and people living with scleroderma. Its programs are designed around the specific challenges faced by the scleroderma community.
SPIN Self is designed to help people:
- Build confidence in managing scleroderma
- Develop practical self-management skills
- Manage everyday symptoms and challenges
- Support overall wellbeing
- Connect with others through peer-led group sessions
The program was developed over several years, including research into how people use online self-management tools. Peer-led sessions were incorporated to help participants work through the resources together and provide mutual support.
Frequently Asked Questions
1. What are digital ulcers in scleroderma?
Digital ulcers are open sores that can develop on the fingers or other areas affected by reduced blood flow, skin changes or repeated trauma. Different types require different approaches to management.
2.How can I help prevent digital ulcers?
Keeping warm, protecting vulnerable areas from trauma, maintaining skin health, not smoking, staying active and working with your healthcare team can all form part of a prevention strategy.
3.When should I seek medical help for an ulcer?
Seek medical advice if an ulcer becomes increasingly painful, throbbing, red, swollen or produces pus, as these can be signs of infection.
4.Why is physiotherapy important for scleroderma?
Physiotherapy can help maintain movement, hand function, strength and general physical wellbeing. A physiotherapist or occupational therapist can also advise on exercises and splinting where appropriate.
5.What is SPIN Self?
SPIN Self is a free online self-management program developed specifically for people living with scleroderma. It aims to build confidence, support symptom management and improve day-to-day wellbeing.
TL;DR
Living with scleroderma can mean managing sensitive skin, Raynaud’s phenomenon, digital ulcers and changes in hand function. During our August Virtual Education Session, rheumatology nurse practitioner Emma Bavage shared practical strategies for preventing and managing skin and digital ulcers, including staying warm, protecting vulnerable areas, maintaining skin moisture, supporting circulation and seeking appropriate medical care when wounds develop. The session also highlighted the importance of physiotherapy, multidisciplinary care and patient advocacy, along with the launch of SPIN Self, a free resource designed to help people with scleroderma build confidence and manage the everyday challenges of living with a chronic condition.
Conclusion
Managing scleroderma involves more than treating individual symptoms. Protecting the skin, preventing ulcers, staying warm, maintaining movement and accessing the right healthcare professionals can all make a difference to everyday life.
Emma Bavage’s presentation highlighted the importance of practical prevention, personalised wound care, multidisciplinary support and patient advocacy. It also reinforced the value of listening to people living with scleroderma and recognising the strategies that work for their individual circumstances.
With resources such as SPIN Self becoming available, people living with scleroderma have more opportunities to build confidence, develop self-management skills and feel better supported in navigating the challenges of a chronic condition.
For those living with Scleroderma, staying updated and informed can make a world of difference. Connecting with others can also be hugely beneficial. Find out more about support in your area by clicking here.
If you’d like to gain firsthand knowledge, our National Education Sessions and Virtual Education Sessions are available to you at no charge. Our Virtual Education Sessions are held every month through Google Meet. You can sign up for these free Virtual Education Sessions by clicking here.
These sessions provide an opportunity to engage with medical professionals and seasoned legal experts who will address common inquiries about Scleroderma and related topics.