Scleroderma en coup de sabre treated with polymethylmethacrylate - Case report

Abstract

The scleroderma en coup de sabre is a variant of localized scleroderma that occurs preferentially in children. The disease progresses with a proliferative and inflammatory phase and later atrophy and residual deformity, which are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting and resection of the lesion. Among the most widely used fillers is hyaluronic acid. However, there are limitations that motivate the search for alternatives, such as polymethylmethacrylate, a permanent filler that is biocompatible, non-toxic, non-mutagenic and immunologically inert. In order to illustrate its application, a case of scleroderma en coup de sabre in a 17-year-old patient, who was treated with polymethylmethacrylate with excellent aesthetic results, is reported.

Surgical Management of Localized Scleroderma

“…Current dermatological medical treatments for localized scleroderma (e.g., immune suppressants) are usually conservative and often do not yield thoroughly satisfying outcomes for patients. Furthermore, most existing research about surgical management options (e.g., filler [ 7 8 ], artificial dermis [ 9 ], artificial bone [ 10 ], hair transplantation [ 11 12 ], or fat or dermofat graft [ 13 14 15 16 ]) are case reports and, thus, lack a systematic analysis. None of our patients experienced significant clinical improvement with medication and were subsequently referred from the dermatology department.…”

“…Because we only reviewed a small number of cases during a short follow-up period, larger studies are needed in the future. Additionally, other new reconstruction methods for treating localized scleroderma, including filler [ 7 8 ], artificial dermis [ 9 ], artificial bone [ 10 ], and hair transplantation [ 11 12 ] would be beneficial to this patient population.…”

“…Due to the limitations of this conservative treatment and patients' expectations for a better quality of life, including aesthetic outcomes, more patients are increasingly preferring surgery over conservative treatment. However, most research into surgical management (e.g., filler [ 7 8 ], artificial dermis [ 9 ], artificial bone [ 10 ], hair transplantation [ 11 12 ], and fat or dermofat graft [ 13 14 15 16 ]) has been case reports, which lack a systemized study design compared with control-design research into medical treatments.…”

Cosmetical treatments of connective tissue disorders

“…Nonpermanent fillers, such as HA and poly-L-lactic acid (PLLA), have been successfully employed to treat atrophy linked to linear morphea, scleroderma, LE, and LE panniculitis (LEP) (Gupta, Bhari, Verma, & Gupta, 2017;Ponzo, Carruthers, & Humphrey, 2017;Thareja, Sadhwani, & Alan Fenske, 2015) Permanent fillers such as polymethylmethacrylate and polyacrylamide hydrogel have also yielded excellent results in scleroderma en coup de sabre and LEP-induced subcutaneous tissue atrophy (Franco, Serra, Lima, D'Acri, & Martins, 2016;Gupta et al, 2017).…”

“…Permanent fillers such as polymethylmethacrylate and polyacrylamide hydrogel have also yielded excellent results in scleroderma en coup de sabre and LEP‐induced subcutaneous tissue atrophy (Franco, Serra, Lima, D'Acri, & Martins, ; Gupta et al, ). Delayed gel induration is one of the principal complications of polyacrylamide filler use, resulting in significant concerns in CTDs (Gupta et al, ).…”