Digital ulcers: sildenafil

What are digital ulcers?

Ulcers on the fingers or toes are known as digital ulcers. These can happen in people with a severe form of Raynaud's phenomenon (also just called Raynaud's). Raynaud's affects the blood supply to the fingers and toes. These change colour and may become painful in cold weather, with a change in temperature, or with emotional stress. The severe form of Raynaud's is usually caused by a condition called systemic sclerosis, in which a person's immune system damages some of the cells in their body. The skin tissue in the fingers or toes becomes damaged and ulcers develop. These are painful and often cause problems with daily tasks, such as eating or dressing.

People with Raynaud's can minimise attacks by avoiding the cold, keeping their hands and feet warm with gloves and socks, and by stopping smoking (smoking can also affect blood supply). In some cases, medicines known as calcium channel blockers (for example, nifedipine) are used. These work by relaxing the blood vessels in the fingers and toes, increasing their blood supply. Only 1 medicine, called bosentan (taken as a tablet), is licensed in the UK for treating digital ulcers. This can be offered by specialist doctors to people with systemic sclerosis who already have digital ulcers, to stop new ulcers developing. Bosentan does not help to heal ulcers that have already developed. Other medicines that are used to treat digital ulcers are iloprost (given by infusion in hospital), or 'phosphodiesterase type 5 (PDE5) inhibitors' such as sildenafil (taken as a tablet).