Abstract
Clinical evaluations of ulcers have been problematic and have often led to failed clinical trials of ulcer treatment. A systematic literature review confirmed that there was a lack of uniformity with an astonishing 74 different definitions in the literature and only one definition developed by a systematic approach. Efforts were started to remedy this situation, with a Delphi process followed by a nominal technique approach which led to the following definition: an ulcer is defined by loss of epidermal covering with a break in the basement membrane (which separates the dermis from epidermis). It appears clinically as visible blood vessels, fibrin, granulation tissue and/or underlying deeper structures (e.g., muscle, ligament, fat) or as it would appear on debridement. In addition, the use of ultrasound was used to further define ulcers, with acceptable intra-rater reliability (ICC: 0.901). Additional efforts are underway to validly define digital tip ulcers both clinically and by ultrasound, with the hope that a useable, practical definition of DU will eventuate for clinical trials (and eventually for clinical practice).
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Furst, D.E., Suliman, Y.A., Denton, C.P., Matucci-Cerinic, M. (2019). Defining Digital Ulcers in Systemic Sclerosis: The State of the Art. In: Matucci-Cerinic, M., Denton, C. (eds) Atlas of Ulcers in Systemic Sclerosis. Springer, Cham. https://doi.org/10.1007/978-3-319-98477-3_1
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DOI: https://doi.org/10.1007/978-3-319-98477-3_1
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