Background Systemic sclerosis (SSc) is a chronic disorder characterized by damage of microcirculation and progressive tissue hypoperfusion that increase the risk for digital ulcers (DU) (1,2). Both local and systemic treatments are indicated for DU (3).
Objectives To observe the evolution of DU, treated for ten days with local medications, by evaluating local blood perfusion (BP) changes by laser speckle contrast analysis (LASCA), a non-contact technique.
Methods Twenty SSc patients with DU of recent onset (mean age 63±12 years, mean disease duration 7±6 years) were enrolled, after informed consent, during their normal follow-up. Patients continued their ongoing treatment with vasodilator drugs, endothelin receptor antagonists (ERA) and immunosuppressive drugs, when indicated. Local BP was evaluated in all patients by LASCA before starting local treatment (T0), both at the level of the dorsal and palmar surface of the hands (4). Different regions of interest (ROIs) were than created at the level of the fingertip, periungual, ulcer and periulcer areas, and the perfusion values were reported as perfusion units (PU) (4). The ulcers were cleaned to remove all tissue debris before the local hydrocolloid dressing was applied, to promote the granulation tissue and to prevent bacteria growth. Hydrocolloid dressings are occlusive medication usually made up of a hydrocolloid matrix bonded onto a vapour-permeable film or foam backing; when in contact with the surface this matrix forms a gel, providing a moist environment (5). The medications were changed every 2 days. After 10 days of treatment (T1) LASCA was repeated, with the same aforementioned modalities. Statistical analysis was performed by non parametric tests.
Results A statistically significant increase of BP was observed from T0 up to T1 in the ROIs created at the level of ulcer area (median 37 vs 57 PU, p<0.0001) (due to the increase of granulation tissue), as well as a significant decrease of BP was observed at periulcer area (median 108 vs 90 PU, p<0.0001) (due to a decreased inflammatory reaction). A positive correlation was observed between fingertip BP and periungual BP at both T0 (r=0.66, p=0.02) and T1 (r=0.44, p=0.05). There was also a positive correlation between fingertip BP and BP at the ulcer level at both T0 (r=0.57, p=0.009) and T1 (r=0.54, p=0.01). At T1, there was a statistically significant decrease of BP difference between fingertip and ulcer area (42 PU and 17 PU, respectively; p<0.0001), between periulcer and ulcer areas (71 and 30 PU, respectively; p<0.0001), and between periulcer and fingertip area (29 and 11 PU, respectively; p=0.0003).
Conclusions LASCA seems to represent a reliable technique to monitor DU evolution at least in SSc patients, since it seems to offer a quantifiable and safe method to evaluate local blood perfusion of the ulcer area during treatment.
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Disclosure of Interest None declared
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