Systemic sclerosis-related digital ulcers: Current understanding and updated management approaches- a primer for clinicians

Digital ulcers (DUs) are a common and debilitating manifestation of systemic sclerosis (SSc), driven by complex vascular dysfunction and mechanical factors, and are associated with substantial pain, disability, infection risk, and higher burden of broader disease. Despite growing insights into the contribution of endothelial injury and impaired angiogenesis, as well as increasing use of imaging and biomarker-based assessments, SSc-related DUs remain an area of significant unmet clinical need. Management is multifaceted, encompassing wound care, vasodilator/active therapies, and selected interventional procedures. Yet major gaps persist in access to specialized care, treatment consistency, and the availability of standardized outcome measures. Continued emphasis on early detection, coordinated multidisciplinary care, and development of more effective and preventative therapies is essential to improve long-term outcomes. Here, we aim to review current knowledge on SSc-related DUs and offer an updated management framework informed by emerging studies over the past five years.