Topical Simvastatin as Treatment of Digital Ulcer in Systemic Scleroderma Tuntas Rayinda, Ika Rizki, Yohanes Widodo Wirohadidjojo Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada / RSUP Dr. Sardjito, Yogyakarta Indonesia Keywords: systemic scleroderma, digital ulcer, statin, topical simvastatin. 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. 1 INTRODUCTION Systemic scleroderma (SS) is a rare connective tissue disorder characterized by extensive fibrosis, vascular damage, immunologic disorder, and various organ involvement (Barsotti et al., 2016). Two of the most common clinical symptoms in SS are Raynaud phenomenon (RP) and digital ulcer (DU). Digital ulcer is defined as ischemic tissue that undergo denudation with clear margin, loss of epidermis and dermis, and found on the fingertips. The ulcer could be found above bone protrusion such as proximal phalanx, but it could also occur due to secondary causes such as trauma. The ulcer is often very painful and disturb hand function (Abraham, 2015; Marvi and Chung, 2010). Digital ulcer occurred in 30% of SS patient. In addition, 66% of DU patients experienced more than one episode of recurrence albeit utilization of vasodilator (Steen et al., 2009). In March 2016-April 2017, there were 17 SS patients on maintenance therapy in the Dermatology and Venereal Disease Clinic of Dr. Sardjito Hospital, Yogyakarta. Four (23.5%) of the SS patients also had DU. Simvastatin, a plasma cholesterol lowering drug, is a competitive inhibitor of HMG-CoA reductase and is known to have anti-inflammatory potency and could accelerate chronic wound healing (Stojadinovic et al., 2014). Topical simvastatin had been reported to have efficacy in healing chronic venous ulcer and diabetic ulcer (Asai et al., 2012; Raposio et al., 2016). This manuscript will report a case of DU in SS that improved after treatment with topical simvastatin. The discussion will focus on simvastatin’s mechanism of action in chronic wound Rayinda, T., Rizki, I. and Wirohadidjojo, Y. Topical Simvastatin as Treatment of Digital Ulcer in Systemic Scleroderma. DOI: 10.5220/0008159804650468 In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 465-468 ISBN: 978-989-758-494-7 Copyright c  2021 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved 465