Scleroderma (Systemic Sclerosis) Skin Fibrosis & Digital Ulcers

Common Symptoms

• Thickened, tight, or hardened skin, especially on the hands and fingers
• Fingertip ulcers or sores that are slow to heal, often related to poor circulation (Raynaud's phenomenon)
• Reduced hand flexibility and function due to skin tightness
• Pain associated with digital ulcers

Why It Happens

Scleroderma is an autoimmune condition in which the immune system triggers excess collagen production and blood vessel changes, leading to skin and tissue fibrosis and, particularly in the fingertips, reduced blood flow that can cause ulcers.

Why It Can Become Persistent

This is a chronic autoimmune disease process, not a one-time injury — the fibrosis and circulatory changes are ongoing, which is why skin symptoms and digital ulcers can persist or recur without disease-directed care.

Who Commonly Gets It

Scleroderma is more common in women and typically develops between ages 30 and 50, though it can occur at any age.

How It Is Usually Diagnosed

Diagnosis is made by a rheumatologist based on clinical features, blood antibody testing, and sometimes specialized imaging of blood vessels in the fingers (nailfold capillaroscopy).

Traditional Treatment Options

• Immunosuppressive or disease-modifying medication: Prescribed by a rheumatologist to address the underlying autoimmune process.
• Vasodilator medications: To improve blood flow and help prevent or heal digital ulcers.
• Wound care for digital ulcers: Local care to support healing and prevent infection.
• Physical and occupational therapy: To help maintain hand function and flexibility.

Why Someone Might Start Looking for Another Option

People managing scleroderma-related skin symptoms and digital ulcers, and their rheumatology teams, are often interested in additional supportive options alongside disease-directed medical care.

Where Shockwave Therapy May Fit

A small pilot study of 30 patients found skin thickness scores improved and local blood vessel measures increased after shockwave therapy, without a control group. A second small trial specifically targeting fingertip ulcers found the number and size of ulcers decreased significantly and pain scores improved over about 20 weeks, though the authors themselves noted it was difficult to fully separate this from ulcers that might have healed on their own, since there was no placebo control. Both studies are genuinely early-stage — small, uncontrolled, single-center — and this research does not address or change the underlying autoimmune disease.

How Shockwave Treatment Works for This Area

Shockwave therapy would only be considered as a supportive adjunct alongside your rheumatologist's ongoing disease-directed care — never as a substitute for it.

What the Treatment Feels Like

Patients typically describe a tapping or pressure sensation at the treatment site; your provider will discuss what to expect based on your evaluation.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone not already under the care of a rheumatologist for scleroderma
• Active digital ulcer infection, which needs to be addressed first
• Significant untreated circulatory compromise, which needs its own evaluation
• Certain neurological or bleeding-related conditions, per your provider's screening

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.