Topical Simvastatin as Treatment of Digital Ulcer in Systemic Scleroderma

Tuntas Rayinda, Ika Rizki, Yohanes Widodo Wirohadidjojo

2018

Abstract

Systemic Scleroderma (SS) is a connective tissue disease characterized by extensive fibrosis, vascular damage, immunologic disorder, and organ involvement. 1 digital ulcer (DU) is a common clinical condition in SS which occurred in 30% of the patients. Simvastatin, a HMG-CoA reductase competitive inhibitor, is known to have anti-inflammatory potency and could accelerate the healing of chronic wound. We report a case of UD in SS that improved with topical simvastatin treatment. A 61 years old woman came to the clinic with a complaint of wounds on the tip of fingers and toes that has not healed for two weeks. The wound initially appeared at the tip of finger, extended, and then similar wound appeared at the tip of toe. The patient was diagnosed with systemic scleroderma since three years ago and treated with methylprednisolone and a vasodilator agent. From physical examination, there were shallow ulcers at the right middle toe and left thumb sized 1x1-2 cm, with irregular border and covered with necrotic tissues. DU management in SS consisted of non-pharmacological, pharmacological, and operative methods. Simvastatin, a statin class drug, was proven to have anti-inflammatory, immune modulatory, and wound healing effects in several studies. The benefit of statin in wound healing process was shown by its ability to improve vascularization in chronic wound through increased VEGF concentration which is disturbed in abnormal wound healing process. Topical simvastatin was also proven to have antimicrobial effect which could potentially prevent bacteria from disrupting epithelialization and wound healing process. The patient was given normal saline compression twice daily followed by application of 0.5% simvastatin in gentamicin ointment twice daily after saline compression. After two weeks of treatment, the ulcers on both fingers and toes improved.

Paper Citation

in Harvard Style

Rayinda T., Rizki I. and Wirohadidjojo Y. (2018). Topical Simvastatin as Treatment of Digital Ulcer in Systemic Scleroderma.In Proceedings of the 23rd Regional Conference of Dermatology - Volume 1: RCD, ISBN 978-989-758-494-7, pages 465-468. DOI: 10.5220/0008159804650468

in Bibtex Style

@conference{rcd18,
author={Tuntas Rayinda and Ika Rizki and Yohanes Widodo Wirohadidjojo},
title={Topical Simvastatin as Treatment of Digital Ulcer in Systemic Scleroderma},
booktitle={Proceedings of the 23rd Regional Conference of Dermatology - Volume 1: RCD,},
year={2018},
pages={465-468},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0008159804650468},
isbn={978-989-758-494-7},
}

in EndNote Style

TY - CONF

JO - Proceedings of the 23rd Regional Conference of Dermatology - Volume 1: RCD,
TI - Topical Simvastatin as Treatment of Digital Ulcer in Systemic Scleroderma
SN - 978-989-758-494-7
AU - Rayinda T.
AU - Rizki I.
AU - Wirohadidjojo Y.
PY - 2018
SP - 465
EP - 468
DO - 10.5220/0008159804650468