Scleroderma: Overview of the Main Advanced Dressings Used in Wound Care

Abstract

Scleroderma, or systemic sclerosis, is a rare and multifaceted autoimmune disorder characterized by fibrosis of connective tissues, vasculopathy, and autoimmune dysfunction, which often leads to debilitating cutaneous manifestations and digital ulcers. This disease poses significant challenges in both clinical management and patient care, particularly regarding the treatment of associated skin lesions. The pathogenesis of scleroderma involves endothelial damage, impaired vascular function, and the secretion of inflammatory mediators like endothelin-1 (ET1), leading to vasoconstriction and fibrosis. Approximately 30% to 50% of patients experience digital ulcers, which are resistant to healing and have a high risk of infection. The management of these ulcers has evolved with the introduction of advanced wound dressings, which now play a pivotal role in promoting healing and reducing complications. These dressings, such as hydrocolloids, polyurethane foams, charcoal, antimicrobial, collagen, and alginate-based products, are designed to manage various stages of wound healing—from debridement in the inflammatory phase to promoting granulation and epithelialization in later stages. The selection of an appropriate dressing is influenced by factors such as lesion stage, exudate level, presence of infection, and patient comorbidities. The hospital pharmacist is integral to this process, contributing to therapeutic selection, economic evaluation, and overall cost-effectiveness. Advanced dressings, despite their higher initial cost, offer long-term savings by reducing treatment duration and the frequency of dressing changes. The multidisciplinary approach, including the expertise of rheumatologists, pharmacists, nurses, and general practitioners, is essential for providing optimal care for scleroderma patients. This review highlights the significant progress in wound care management for scleroderma and emphasizes the importance of tailored treatments to enhance healing and patient outcomes.