Treatment of ischaemic digital ulcers and prevention of gangrene with intravenous iloprost in systemic sclerosis.
Twelve patients with systemic sclerosis were treated with intravenous infusions of the prostacyclin-stable analogue iloprost 0.5-2.0 ng/kg/min for 6 h from 8 to 13 days. Imminent gangrene was stopped in 2 patients and followed by healing. In 4 of 6 patients iloprost led to complete healing of ischaemic ulcers and in the remaining 2 patients to partial healing. One patient with severe Raynaud's phenomenon discontinued the study after 3 days due to severe headache. The 2 remaining patients with Raynaud's phenomenon as an indication improved, while no improvement was recorded in a patient with vasculitis of the lower leg. Side-effects such as headache, nausea and flushing were the reason that only 5 patients reached the maximum infusion rate. No statistical differences were recorded in digital bloodflow before and after the study or in plasma endothelin in the 9 patients investigated. Three of the 6 patients with healing ulcers, however, showed a pronounced decrease in plasma endothelin. Iloprost appears useful as a treatment of imminent gangrene and ischaemic ulcers in systemic sclerosis. This reparatory capacity could also be of a more general importance in therapy of this disease.
Zachariae
H
H
Department of Dermatology, Marselisborg Hospital, Aarhus, Denmark.
Halkier-Sørensen
L
L
Bjerring
P
P
Heickendorff
L
L
D000328:Adult; D000368:Aged; D016232:Endothelins / Q000097:blood; D005260:Female; D005385:Fingers / Q000098:blood supply*; D005734:Gangrene / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016285:Iloprost / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D007511:Ischemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011928:Raynaud Disease / Q000188:drug therapy / Q000209:etiology; D012595:Scleroderma, Systemic / Q000097:blood / Q000150:complications*; D014456:Ulcer / Q000188:drug therapy / Q000209:etiology; D014665:Vasodilator Agents / Q000009:adverse effects*
D016232:Endothelins; D014665:Vasodilator Agents; D016285:Iloprost