How Digital Sclerosis Affects People with Diabetes

Patients with diabetes are at increased risk for developing skin complications as a result of the metabolic disruption that occurs in this condition.

The fingers are also called digits, and sclerosis refers to the process of stiffening and hardening of the body’s tissue from inflammatory conditions. Digital sclerosis occurs when the skin of the fingers become tight and thickened, changing the appearance of the fingers and limiting finger movement.

Symptoms

Digital sclerosis that occurs in people with diabetes is characterized by thickened and tightened skin of the fingers that is waxy in appearance. It is often painless, but can cause decreased sensation of the fingers.

Digital sclerosis develops slowly over time in a symmetrical fashion, affecting both hands, especially on the back of the fingers. It may also progress to the hands, arms, and body.

Diabetic Cheiroarthropathy

Digital sclerosis also often coincides with diabetic cheiroarthropathy, commonly called diabetic stiff hand syndrome, where stiffening of the body’s tissues also affects the hand joints and fingers. With diabetic cheiroarthropathy, increased joint stiffness limits the mobility of the fingers, making it difficult or impossible to fully bend and extend the fingers.

The Prayer Sign

In advanced stages of digital sclerosis, contractures of the finger flexor tendons can occur. When this happens, people with diabetes will exhibit a “prayer sign,” the inability to press the palms of the hands together completely due to stiffening of the skin and tendons of the hands and fingers.

A Dupuytren's contracture develops when there is thickening, hardening, and shortening of the palmar fascia, a connective tissue of the palm that overlays the finger tendons, resulting in visible tightening. This reduces your ability to fully extend one or more fingers, most commonly the ring finger. However, the index, middle, and pinky fingers can be affected as well.

Trigger Finger

Sclerosis (thickening and hardening) of the tendon sheaths surrounding the finger tendons can also occur. Flexor tenosynovitis, commonly called trigger finger, is another complication that occurs with progression of diabetes. It causes tightening of one of the fingers into a bent position.

People with trigger finger will report feeling a catching or locking sensation in the finger tendon with movement, and a palpable lump on the palm of the hand and finger can be felt.

Causes

Digital sclerosis is thought to occur due to a variety of different factors. While the exact underlying cause is unknown, damage to blood vessels and nerves that commonly occurs in diabetes can contribute to stiffening and thickening of the skin of the hands and fingers.

This is because this damage results in deprivation of an adequate supply of oxygen and nutrients in tissues. Nerve and blood vessel damage occurs in diabetes from the inflammatory effects that increased blood sugar levels cause throughout the body.

Glycosylation, a process in which excess sugar molecules from the bloodstream are bound to protein molecules, including the collagen that makes up your skin and joints, also leads to the stiffening of skin, tendons, and joints of the fingers.

Risk Factors

Digital sclerosis and related complications like diabetic cheiroarthropathy, Dupuytren's contractures, and trigger finger increase with a longer duration of diabetes.

Digital sclerosis and other conditions that cause stiffening of connective tissues are more likely to occur in people with a long history of type 1 diabetes, but can also occur in those with type 2 diabetes.

There are no significant differences in risk between men and women or among different ethnic groups.

Type 1 Diabetes

Type 1 diabetes, once called juvenile diabetes, is a condition that develops because the beta cells of the pancreas cannot produce insulin. Without a sufficient level of insulin, excess blood sugar cannot be transported out of the bloodstream and into cells to be used for energy. This results in chronically elevated blood sugar.

People with type 1 diabetes are more likely to develop digital sclerosis than those with type 2 diabetes, especially because people with type 1 diabetes usually have a longer history of having the condition.

Type 2 Diabetes

While digital sclerosis primarily occurs in people with type 1 diabetes, it can also occur in those with type 2 diabetes with a long history of the condition and poor control over their blood sugar. Type 2 diabetes results from chronically elevated blood sugar levels when the body becomes insulin-resistant, meaning the body stops activating the release of insulin to remove excess sugar from the blood, even though the beta cells can make insulin.

Type 2 diabetes results from a variety of factors, but a diet high in sugar and refined carbohydrates and an inactive lifestyle with little exercise contribute most to high blood sugar for long periods of time, to the point where the body no longer releases insulin because this state of high blood sugar is considered a new normal. Making better dietary choices and exercising regularly can help lower the risk and severity of type 2 diabetes.

Treatment

Getting Blood Sugar Under Control

Treatment options for digital sclerosis are limited. There is no evidence for treatment options to cure digital sclerosis or reverse symptoms, but the most effective way to prevent and prevent worsening of digital sclerosis and related complications is through improving blood sugar control.

Physical Therapy

Physical therapy may help improve range of motion of the finger joints to reduce contractures and maintain joint mobility. Corticosteroid injections into the hands may be used to reduce tightness and inflammation with Dupuytren's contractures or trigger finger.

In severe cases, surgery may be needed to release the tightened tendons and connective tissue of the palm to restore functional hand and finger use.

Coping

While there is no cure for digital sclerosis, you can learn to cope with your condition by regularly stretching your hands and fingers to prevent the skin and tendons from getting more stiff and tight. Hand and finger exercises to work on your grip strength and improve the mobility of your fingers are helpful for preventing the worsening of digital sclerosis. Digital sclerosis is not typically painful, so pain management treatments are often not needed.

Summary

Digital sclerosis is common among people with a long history of diabetes. There is no cure for the condition, but keeping your blood sugar under control and making positive lifestyle changes like exercising more and eating healthy can prevent or improve digital sclerosis.

A Word From Verywell

Digital sclerosis is a long-term complication of diabetes that often results when blood sugar is not effectively managed. While there is no cure for digital sclerosis, regularly monitoring blood sugar levels and keeping them stable through administering insulin, medication, or lifestyle changes like diet and exercise can help reduce the risk of developing digital sclerosis and other long-term complications of diabetes.