New Treatment Shows Promise for Scleroderma-Induced Orofacial Changes

A recent article published on Medscape.com highlights significant advancements in addressing orofacial changes associated with scleroderma, offering hope to patients struggling with the aesthetic and functional impacts of this condition.

Understanding Patient Concerns

According to the Medscape article, a 2003 study revealed that patients with systemic sclerosis (scleroderma) express considerable concern about specific orofacial features. The study found that a high percentage of respondents were troubled by thin lips (73%), mouth furrows (80%), loss of facial lines (68%), and a smaller, tighter mouth (77%).

Dr. Kathleen Cook Suozzi, director of the Aesthetic Dermatology Program at Yale University School of Medicine, emphasized the impact of these changes, stating, “Patients with systemic sclerosis may have loss of vermilion lip, microstomia, and perioral rhytids.”

Promising Treatments Emerge

The article reports on recent research demonstrating the potential of hyaluronidase injections in improving orofacial changes commonly experienced by scleroderma patients. A 2019 case study from Alabama described successful treatment of a 53-year-old woman with scleroderma-induced microstomia using hyaluronidase injections.

Further evidence comes from a 2023 cohort study involving four women with autoimmune sclerosing conditions resulting in oral microstomia. The Medscape article notes that following hyaluronidase injections, all participants showed improvements in mouth opening capacity and Mouth Handicap in Systemic Sclerosis (MHISS) scores.

Yale Study Shows Promising Results

Dr. Suozzi and her colleagues conducted a retrospective study of 12 women with scleroderma who received hyaluronic acid (HA) filler for microstomia. The results, pending publication in JAAD Case Reports, showed significant improvements in oral aperture measurements.

Dr. Suozzi reported, “In general, patients needed three to four treatments to reach peak effect, and then they reached a plateau.” She added, “Interestingly, we found that if the patient’s disease flared and their microstomia started to return, when you rechallenged them, they continued to respond. So, patients can continue to use this treatment over time.”

Lip Augmentation Study

The Medscape article also mentions a separate case series conducted by Dr. Suozzi and her team, which evaluated the effect of HA soft tissue filler for lip augmentation in seven patients. The study reported statistically significant increases in lip fullness and positive aesthetic improvement scores.

Practical Considerations for Treatment

Dr. Suozzi provided practical advice for administering these treatments, recommending the use of nerve blocks and minimizing injection points. She stated, “Initially, we were using 30% lidocaine preparations around the mouth for an hour before the procedure, and patients were still having pain, so now we use nerve blocks.”

The article concludes with Dr. Suozzi’s encouraging words about the accessibility of this treatment: “This is a really easy treatment to perform, and I think it can be done in the office of a general dermatologist.”

These findings, as reported by Medscape, offer new hope for scleroderma patients dealing with orofacial changes, potentially improving both their aesthetic concerns and quality of life.