Hyaluronic Acid and Platelet-Rich Plasma May Be an Efficient Alternative in Scleroderma

woman getting injection
Unrecognizable woman having her lips and nasolabial folds done at private medical clinic. Syringe at focus.
Researchers evaluated the response of patients with scleroderma to filler injections of hyaluronic acid together with platelet-rich plasma.

Filler injections of platelet-rich plasma and hyaluronic acid can be an efficient therapeutic alternative that significantly improves quality of life in patients with scleroderma, according to study results published in Arthritis Research & Therapy.

To address the lack of specific and effective therapies in systemic sclerosis (SSc), researchers conducted a prospective, open-label, monocentric single-arm study that evaluated how women with SSc and perioral fibrosis (n=10; age range, 18-70 years), who were enrolled in the Rheumatology Section of Policlinico “Paolo Giaccone” of Palermo, responded to filler injections of hyaluronic acid combined with platelet-rich plasma.

Three perioral injections at an interval of 15 to 20 days were given on the same day that evaluations were made, using a digital electronic caliber to monitor changes in maximum mouth opening, intercommissural distance (measured from 1 labial commissure to the other, along with vermillion edge of lower lip with occluded teeth), distance between upper and lower incisors, and thickness of upper and lower lip. Photographs of patients from the frontal and three-quarters right and left were taken before and after every injection.

Significant improvements were seen in all clinical parameters starting with the first injection, and improvement from baseline was maintained through treatment and in the follow-up of up to 2 years. Eight of the 10 patients (80%) showed increased upper lip thickness and a greater mouth opening during the 1-month follow-up, and these results were maintained over 2 years (maximum mouth opening: baseline, 47.61 mm; month 1, 50.91 mm; month 2, 50.35 mm; month 3, 49.23 mm; 2 years, 48.60 mm; P <.0001; and upper lip thickness: baseline, 4.20 mm; month 1, 5.25 mm; month 2, 5.65 mm; month 3, 4.75 mm; 2 years, 4.45 mm; P  <.0001). At the 1-month follow-up and through 2 years, increases were seen among all patients in terms of distance between upper and lower incisors (baseline, 27.05 mm; month 1, 30.65 mm; month 2, 30.41 mm; month 3, 29.03 mm; 2 years, 28.14 mm; P <.0001), intercommissural distance (baseline, 49.12 mm; month 1, 51.54 mm; month 2, 53.43 mm;  month 3, 51.44 mm; 2 years, 50.31 mm; P <.0001), and lower lip thickness (baseline, 3.80 mm; month 1, 5.10 mm; month 2, 5.75 mm; month 3, 4.85 mm; 2 years, 4.25 mm; P <.0001).

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Investigators concluded that while the small sample size of this study indicated the need for findings to be confirmed in larger cohorts of patients, “this study has shown the efficacy of hyaluronic acid and platelet-rich plasma infiltrations in the treatment of facial skin lesions in [patients with] SSc. In fact, it has guaranteed a satisfactory result both from an esthetic and a functional point of view, not only visually but also instrumentally observed.”


Pirrello R, Verro B, Grasso G, et al. Hyaluronic acid and platelet-rich plasma, a new therapeutic alternative for scleroderma patients: a prospective open-label study. Arthritis Res Ther. 2019;21(1):286.