Hyaluronic acid and platelet-rich plasma, a new therapeutic alternative for scleroderma patients: a prospective open-label study

Abstract

BackgroundSystemic sclerosis is a systemic connective tissue disease characterized by endothelium damage, fibrosis, and subsequent atrophy of the skin. Perioral fibrosis produces a characteristic microstomia together with microcheilia, both of which cause severe difficulties and affects patients’ daily life, such as eating and oral hygiene. Since there are no effective and specific therapies, we have aimed at evaluating the response to filler injections of hyaluronic acid together with platelet-rich plasma.MethodsTen female patients aged between 18 and 70 were included in this study. Each patient was treated with three filler injections of hyaluronic acid and platelet-rich plasma at an interval of 15 to 20 days. Follow-up check-ups were recorded 1, 3, and 24 months after the end of the treatment. During the therapy and the subsequent follow-up, we evaluated the mouth’s opening, freedom of movement of the lips, and skin elasticity.ResultsAfter the treatment, patients had achieved good results already after the first injection and the improvement was maintained in the following months, up to 2 years. In particular, 8 (80%) patients showed a greater mouth’s opening and increased upper lip’s thickness during 1-month follow-up and maintained these results after 2 years (maximum mouth’s opening T0 47.61; T3 49.23; T4 48.60 p < 0.0001. Upper lip’s thickness T0 4.20; T3 4.75; T4 4.45 p < 0.0001). Moreover, distance between upper and lower incisors (T0 27.05; T3 29.03; T4 28.14 p < 0.0001), inter-commissural distance (T0 49.12; T3 51.44; T4 50.31: p < 0.0001), and lower lip’s thickness (T0 3.80; T3 4.85, 5.10; T4 4.25; p < 0.0001) were increased in all of patients in 1-month follow-up, keeping these benefits after 24 months and having a significant increase of skin elasticity 1 month after the end of therapy.ConclusionsOur study demonstrates that filler injections of hyaluronic acid and platelet-rich plasma represent an efficient local therapeutic alternative for patients affected by scleroderma. The treatment has significantly improved patients’ quality of living.

A Mixed Method Study to Explore the Feasibility and Patient Satisfaction of Two Different Exercise Programs in Systemic Sclerosis Associated Microstomia

“…Further research for long-term follow up is necessary. A recent study (9) suggests that a treatment with injections (hyaluronic acid and platelet-rich plasma) also improve both maximal oral aperture as quality of life. It is noteworthy that these injections require general anesthesia and are invasive procedures.…”

“…Various interventions have been examined. Exercises (5)(6)(7)(8) as well as injection therapy (9) have been suggested to restore or maintain mouth opening and freedom of lip movement to improve patients' quality of life. Several studies have shown that stretching (placing the thumbs in opposite corners of the mouth and pulling outward) and oral augmentation exercises (training with tongue depressors) can increase oral aperture in patients with SSc (5)(6)(7)(8).…”

Lip enhancement and mouth corner lift with fillers and botulinum toxin A

“…In an open trial, 10 female patients (aged 18 to 70 years) were treated with three filler injections of linear, non-cross-linked, mediumhigh molecular weight hyaluronic acid, and platelet-rich plasma at an interval of 15 to 20 days. 42 T A B L E 1 Multicenter trials with HA fillers F I G U R E 1 A, 52-year-old patient with localized fat pads in the lower third of the face and also in the cervical region. Flaccidity is seen in these areas.…”

“…In an open trial, 10 female patients (aged 18 to 70 years) were treated with three filler injections of linear, non‐cross‐linked, medium‐high molecular weight hyaluronic acid, and platelet‐rich plasma at an interval of 15 to 20 days 42 …”

Additional Treatment for Digital Ulcers in Patients with Systemic Sclerosis: A Prospective, Open-Label, Multi-Arm Study for the use of Platelet-Rich Plasma-Lipofilling and Ultrasound-Based Treatments

“…Although there are no speci c pharmacological treatments for skin involvement in SSc, many strategies have been tried [17][18][19], such as corticosteroids and immunomodulators [20], UVA phototherapy [21][22][23], topical calcitriol [24] and retinoids [25]. Moreover, several local therapies have also been investigated to guarantee a satisfactory aesthetic and functional result, especially for facial brotic skin changes, such as injection of autologous fat grafting and Platelet-Rich Plasma (PRP) [26,27] or of a combination of adipose-derived stromal cells (ADSCs) in hyaluronic acid (HA) solution [28] or of HA and PRP [29].…”