Effectiveness of the EmoLED Medical Device in the Healing of Digital Ulcers in Patients With Scleroderma. (SUITABLE)

Description

This clinical study will be a prospective, randomized controlled study, with the commercial objective of assessing the clinical effectiveness of a portable battery powered device that uses blue LED.

This clinical study aims to compare the existing standard treatment for acral ulcers in patients suffering from scleroderma, to a protocol that provides for the administration of the EmoLED treatment for 16 consecutive weeks in addition to the conventional therapy.

The objective is to determine any differences in outcome between the two groups considered and whether the therapy of the treatment group is a valid alternative to the current therapy in terms of support for the reparative process, speed of healing and pain reduction.

The study protocol also establishes a follow-up period of 4 weeks. If the injury has not healed within the 16 weeks of treatment, the patient will return to the investigator centre for the usual dressing, and the evolution of the injury will be observed for 4 weeks. If the recovery occurs within the 16 weeks of treatment, the patient will return to the investigator centre 4 weeks after recovery, for a check-up, during which the condition of the healed skin area and the presence of any relapses will be evaluated.

In this clinical study, patients with systemic sclerosis with at least one ulcerative lesion on the upper limbs' fingers will be enrolled. In case the patient has more than one lesion, only one will be selected for the study; it will be the one that, in the opinion of the doctor, allows a better recording of data (image acquisition).

The population subject matter of the study is largely representative of the target population, as there are no particular exclusion criteria and the center involved is a structure of excellence in the treatment of acral ulcers of sclerodermal origin.

Scleroderma, or systemic sclerosis, is a chronic systemic disease with autoimmune pathogenesis, characterized by skin and internal organs fibrosis caused by an altered functionality of fibroblasts, the presence of perivascular inflammatory infiltration and small vessel alterations and immune system abnormalities.

The incidence of scleroderma is estimated in about twenty cases per million inhabitants per year. The peak age range for the onset of this disease is between 45 and 65 years and, as often observed in autoimmune diseases, women are more frequently affected with a ratio of 4.5:1.

Scleroderma begins in most cases with the Raynaud's phenomenon, consisting in the change of colour of the extremities, which become initially pale, then cyanotic and finally red.

The most characteristic sign of scleroderma is the thickening of the skin, that can be found at the level of the hands, which can meet a progressive deformity in fingers bending, and then also at the level of the wrists, forearms, face and trunk.

There are still no drugs that can cure scleroderma. The treatments used, therefore, aim to contain the symptoms and to avoid/delay the complications of the disease. The most commonly used drugs include vasodilators, pro-kinetic drugs, antiarrhythmics and immunosuppressants to treat the various complications.

Digital ulcers represent a complication that affects about half of patients with systemic sclerosis. Digital ulcers are mainly the consequence of vascular phenomena typical of the disease (Raynaud phenomenon and endothelial damage) or of its fibrotic evolution (skin sclerosis). They are mainly located at the extremities where peripheral vascular phenomena are more evident, at the level of the areas where the skin is most subjected to traction (e.g. the elbows), or in the areas affected by calcinosis. Ulcerations of the knuckles and fingertips are frequent.

Digital ulcers often develop a chronic trend over time, they have a slow healing, they are intensely painful and can lead to a severe functional limitation, compromising the personal and professional quality of life of the affected person, so much so that it represents one of the most important complications from this point of view, perceived by patients as seriously disabling. This type of ulcers can also lead to infectious complications (osteomyelitis, sepsis of the surrounding soft tissues) that in the most serious cases lead to the necrosis of the local tissue resulting in the amputation of the digital phalanges.

Factors to consider in assessing the type of the ulcer include location and size, margins and edges, wound bed, degree of moisture (exudate), edema (local or diffused), pain assessment and degree of infection. From these factors we can distinguish three types of ulcers: superficial, intermediate and deep. The management of a digital ulcer is particularly complex and may involve a local therapy, a systemic therapeutic approach, or a combined therapy.

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