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Scleroderma ulcero

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So I have a patient that has small necrotic ulcers on her toes. Initially, they were classified as arterial ulcers by the admitting nurse. Patient is not able to give a good he due to being over medicated at the hospital and due to other issues. She did mention to me that she had scleroderma so I did some investigating since I wasn't familiar with the disease. I think this is what her issue is after looking around on line but not sure how to treat it. Any insight or suggestions would be appreciated!

My experience with treating scleroderma related wounds is minimal but I will say that it is challenging. I think your best bet would be getting a consult for the patient with a dermatologist or wound care physician. My goal for my unfortunate patient was infection prevention and palliative care. I also recommend offloading the wounds, appropriate footwear for offloading. Depending on the level of tissue damage, I would also be concerned about bone involvement. Podiatry may also be a good idea.