Session Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s – Clinical Aspects and Therapeutics II
Session Type: Abstract Submissions (ACR)
Systemic Sclerosis (SSc) is an autoimmune disease characterized by varying degree of fibrosis in skin and other tissues. Therapeutic options for fibrotic changes are very limited. Particularly aesthetic and facial dysfunctions are followed by important oral and facial manifestations with loss of skin folds around mouth, thinned and rigid lips and tongue rigidity. Limitation of mouth opening leads to deterioration in dental health and decreases the quality of life in SSc patients.
We performed a prospective pilot study to evaluate whether the autologous fat administration in SSc patients can improve the functional limitations related to the impairment of the perioral sclerotic tissue.
Methods: 20 patients with the diffuse form of SSc (mean age + SD 34.5+15 yrs and disease duration of 11+10 yrs) were treated by topical perioral administration of autologous fat graft. All the patients had perioral skin fibrotic changes with limited opening of the mouth (< 50mm) and limited accessibility to the oral cavity. Lipofilling was performed according to the Coleman tecnique, with scar release and implantation into parallel tunnels on multiple layers under the scars. A volume of 5 to 7 cc was injected using an 18-gauge needle. Follow-up was performed at 1, 3 and 6 months postoperatively by evaluating measure of inter-incisal distance and dermal thickness by high frequency ultrasound (US). A pre-treatment and 24 week post-treatment evaluation of microcirculatory abnormalities was made using labial video capillaroscopy and skin biopsy.
All patients made good postoperative recovery without major complications. Sixteen of 20 patients had an immediate subjective improvement of their skin stiffness obviously attributable to release of severe scar contractures. One month after lipofilling, the median measure of inter-incisal distance was significantly increased in comparison with the score before treatment (p=0.038). Three and 6 months after treatment, the median measures were increased further (p<0.02). US evaluations showed that skin thickness resulted significantly lower after treatment (p<0.001). Four patients underwent two lipofilling sessions because of improvement with the first lipofilling but had remaining sclerotic perioral areas. Interestingly 2 patients reporting trigeminal neuropathy, showed the complete resolution of painful syndrome. Finally, labial capillaroscopy of treated patients showed significant improvement in microvascular patterns after lipofilling in term of a more homogeneous capillary density, increased length and reduced diameter shapes. Skin capillary density measured by Hematoxylin Eosin and Safran staining showed upregulation of vessel number by 1.80-fold after lipostructure.
Conclusion: Our study suggest that fat grafting treatment of fibrotic perioral changes in SSc can provide immediate and long-lasting benefits in terms of both aesthetic and functional improvement, and should be considered as a component of comprehensive care. In addition, we provides evidences that adipose tissue graft has the potential to favour neovascularization in SSc. The cellular and/or tissue mechanisms underlying these changes need further investigation.
N. Del Papa,
G. Di Luca,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/autologous-lipostructure-in-the-treatment-of-fibrotic-perioral-changes-in-systemic-sclerosis-a-pilot-study/