title: Scleroderma and evidence based non-pharmaceutical treatment modalities for digital ulcers: a systematic review.
abstract: OBJECTIVE
  Digital ulcers are difficult to heal, increasing the chance of infection, gangrene, amputation and limited functional use of hands. They are a complication in scleroderma or systematic sclerosis (SSc) and occur in approximately 50% of patients. This is a systematic review of the evidence supporting the use of non-pharmaceutical therapeutic modalities and their effectiveness to facilitate the healing of chronic digital ulcers in patients with scleroderma.
  
  
  METHODS
  A comprehensive review of computerised databases from 2000-2013: PubMed/MEDLINE, CINAHL, Pedro, OT Seeker, OT Search, OVID, and Proquest as well as manual review of other resources was completed using the following search terms scleroderma or systemic sclerosis and/or digital ulcers, specific modalities (low level laser therapy, electrical stimulation, intermittent compression, ultrasound, vitamin E, myofascial release, wound dressings, iontophoresis, negative pressure therapy, and exercise), chronic wounds, and wound care. English language studies, from 2000 to January 2013, which used therapeutic modalities to facilitate healing of digital ulcers and use healing of the digital ulcer as an outcome measure were reviewed.
  
  
  RESULTS
  Of the 403 identified articles, only 11 studies addressed non-pharmaceutical treatment modalities to facilitate healing for digital ulcers. Exercise had no direct effect on healing ulcers. The following studies were positive but have limitations in design and sample size:: hyperbaric oxygen therapy (n=2), negative pressure therapy (n=1), intermittent compression (n=27) and acoustic pressure wound healing (n=1). Vitamin E gel showed a significant difference compared to a control group (n=27). Iontophoresis studies have shown that the modality increases blood flow but the results in five different studies are mixed and the application and intensity were inconsistent.
  
  
  CONCLUSIONS
  No one modality was proven to be the most effective. Larger efficacy studies on treating digital ulcers are needed in order to develop appropriate care guidelines to improve outcomes, promote function and lower health-care costs.
authors.affiliation: Assistant Professor; Department of Occupational Therapy Kean University 1000 Morris Avenue Union, New Jersey 0708.
authors.forename: M E
authors.initials: ME
authors.lastname: Moran
mesh_terms: D058128:Compression Bandages; D019317:Evidence-Based Medicine; D005383:Finger Injuries / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D054843:Negative-Pressure Wound Therapy; D012595:Scleroderma, Systemic / Q000150:complications* / Q000628:therapy*; D014456:Ulcer / Q000150:complications* / Q000628:therapy*; D014945:Wound Healing
keywords: Scleroderma; chronic digital ulcers; systematic sclerosis; therapeutic modalities; wound healing