Nécroses digitales

Abstract

As digital ulcers usually reflect focal ischemia due to a microangiopathy, digital gangrene is more likely to be the consequence of a macroangiopathy which can also sometimes be associated with a microangiopathy. Digital gangrene is a common skin manifestation of connective tissue diseases, especially systemic sclerosis. Other multiple causes are possible: Buerger's disease, occupational diseases (particularly hypothenar hammer syndrome) or obstructive vascular disease due to subclavian artery embolism or cardiac embolism. More rarely vasculitis, cryoglobulinemia, polycythemia vera and essential thrombocythemia or solid cancer are associated with digital gangrene, sometimes as a first manifestation. Drug-induced digital gangrene should in all cases be checked (particularly bleomycine and interferon alpha). A thorough clinical examination is frequently enough to evoke a specific cause. Cardiac and upper limbs echo-Doppler, biological examination looking for an inflammatory syndrome, an abnormal blood formula, the presence of a cryoglobulinemia, antineutrophil and antinuclear antibodies is mandatory. In some cases, upper limb arteriography is needed to identify a mechanism such as subclavian aneurism or atherosclerotic plaques or to confirm digital arteritis as shown in Buerger's disease. Limited amputation is frequently needed, but may sometimes occur spontaneously. The main treatment is to treat the cause.