sildenafil-citrate and Ulcer

Topics: Autoantibodies; Dermatomyositis; Humans; Interferon-Induced Helicase, IFIH1; Sildenafil Citrate; Skin Ulcer; Ulcer

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is a form of a rare, clinical subtype of systemic sclerosis, known as limited systemic sclerosis. Limited systemic sclerosis, including CREST syndrome, manifests as fibrotic skin changes restricted to the hands and face, with vascular, musculoskeletal, and visceral involvement. We present a case of a 75-year-old woman with a longstanding history of CREST syndrome complicated by a digital ulceration and persistent pain associated with recalcitrant Raynaud phenomenon. After failing a number of first-line pharmacologic therapies such as diltiazem, sildenafil, and topical nitropaste, the patient was started on a trial of botulinum toxin for the left second digit, with 10 unit injections into both webspaces for a total of 20 units. Following injection, the patient reported no further baseline pain in the affected finger and an over fifty-percent improvement in discomfort with manipulation of the digit at a follow-up time of one week. The ulceration started healing within the following three weeks. This result was maintained at a follow-up time of six weeks.

Topics: Acetylcholine Release Inhibitors; Administration, Topical; Aged; Botulinum Toxins; CREST Syndrome; Diltiazem; Female; Humans; Nitroglycerin; Pain; Raynaud Disease; Sildenafil Citrate; Treatment Failure; Ulcer; Vasodilator Agents

Digital ulcers in progressive systemic sclerosis (PSS) are often refractory to therapy. A frequently chronic aggressive course can lead to the loss of acral limbs involved. A 73-year-old woman developed a dramatic worsening of her ulcerations despite maximum conventional therapy. Switching therapy to bosentan and sildenafil, both in low-dose regimens, resulted for the first time in ten years in a complete healing of the ulcers. If substantiated in a series of patients, the additive and perhaps synergistic clinical benefits of combining bosentan and sildenafil may be a valuable option for the treatment of acral ulcers in PSS.

Topics: Aged; Bosentan; Drug Therapy, Combination; Endothelin Receptor Antagonists; Female; Fingers; Hand Dermatoses; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Scleroderma, Diffuse; Sildenafil Citrate; Sulfonamides; Sulfones; Treatment Outcome; Ulcer

Topics: Esophageal Diseases; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Tablets; Ulcer