Platelet-rich plasma for the treatment of scleroderma-associated ulcers: a single-center experience and literature review
Accepted: 4 February 2024
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Systemic sclerosis (SS) is a complex connective tissue disease characterized by vasculopathy and progressive fibrosis, primarily considered an autoimmune disorder. SS can affect multiple organs and tissues, including the skin, respiratory, gastrointestinal, genitourinary, cardiovascular, and musculoskeletal systems. Skin involvement is common, and SS-related ulcers, especially digital ulcers, occur in roughly 50% of patients. These ulcers not only cause pain but also significantly impact patients’ quality of life, and in severe cases, they can lead to infection, gangrene, and amputation. The search for novel therapies for scleroderma-related ulcers remains an ongoing research area. Platelet-rich plasma (PRP) has been investigated as a potential treatment for difficult-to-heal ulcers, including diabetic, pressure, and vascular ulcers. In this study, we share our experience in treating scleroderma ulcers with PRP. Ten patients with confirmed SS and chronic skin ulcers lasting at least six weeks, which had not responded to conventional treatments, were selected for the study. Homologous PRP gel was prepared and applied once a week for up to eight weeks. The ulcers were documented photographically before and after PRP treatment, and pain levels were assessed using a visual analog scale (VAS). We also conducted a systematic review of the literature focusing on the use of PRP in the setting of SS. The results from our casuistry showed that the ten patients, including eight females and two males with a median age of 52.5 years, had ulcer sizes ranging from 0.78 cm2 to 28.26 cm2. The ulcers were located on fingers, legs, and heels, and they were associated with various forms of SS, including limited and diffuse cutaneous involvement. Raynaud’s phenomenon was prevalent, and two patients exhibited organ involvement. The average ulcer size at the end of PRP treatment decreased significantly, with a 78% reduction in ulcered area. Pain levels also markedly improved, as indicated by a reduction in VAS scores. With regards to systematic revision of literature, we retrieved 45 cases of SS treated with PRP-based therapeutic regimes. However, only a minority of them (n=16) underwent PRP treatment for the treatment of SS-related ulcers. An improvement in wound size and pain has been documented in all cases. Taken together, these data highlight the potential benefits of using homologous PRP in the treatment of scleroderma ulcers, emphasizing its positive impact on ulcer size reduction and pain relief.
Kowalska-Kępczyńska A. Systemic scleroderma-definition, clinical picture and laboratory diagnostics. J Clin Med 2022;11:2299.
Giuggioli D, Manfredi A, Lumetti F, Colaci M, Ferri C. Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature. Autoimmun Rev 2018;17:155-64.
Kowal-Bielecka O, Fransen J, Avouac J, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis 2017;76:1327-39.
Hesseler MJ, Shyam N. Platelet-rich plasma and its utility in medical dermatology: a systematic review. J Am Acad Dermatol 2019;81:834-46.
Matucci-Cerinic M, Krieg T, Guillevin L, et al. Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry. Ann Rheum Dis 2016;75:1770-76.
Costedoat I, Masson M, Barnetche T, et al. Locoregional treatments for digital ulcers in systemic sclerosis: a systematic review. Acta Derm Venereol 2021;101:adv00478.
Paganelli A, Contu L, Condorelli A, et al. Platelet-rich plasma (PRP) and adipose-derived stem cell (ADSC) therapy in the treatment of genital lichen sclerosus: a comprehensive review. Int J Mol Sci 2023;24:16107.
Meznerics FA, Fehérvári P, Dembrovszky F, et al. Platelet-rich plasma in chronic wound management: a systematic review and meta-analysis of randomized clinical trials. J Clin Med 2022;11:7532.
Motolese A, Vignati F, Antelmi A, Saturni V. Effectiveness of platelet-rich plasma in healing necrobiosis lipoidica diabeticorum ulcers. Clin Exp Dermatol 2015;40:39-41.
Abellan Lopez M, Philandrianos C, Daumas A, et al. Assessing the effect of PRP addition to facial micro-lipofilling for patients suffering from scleroderma: a prospective routine care analysis. Ann Chir Plast Esthet 2023;68:152-61.
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;21:286.
Virzì F, Bianca P, Giammona A, et al. Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients. Stem Cell Res Ther 2017;8:236.
Kanemaru H, Kajihara I, Yamanaka K, et al. Platelet-rich plasma therapy is effective for the treatment of refractory skin ulcers in patients with systemic sclerosis. Mod Rheumatol 2015;25:660-1.
Giuggioli D, Colaci M, Manfredi A, et al. Platelet gel in the treatment of severe scleroderma skin ulcers. Rheumatol Int 2012;32:2929-32.
Shetty S, Shenoi SD. Autologous platelet-rich fibrin in treatment of scleroderma ulcer. Int Wound J 2016;13:1065-16.
Palumbo VD, Rizzuto S, Damiano G, et al. Use of platelet concentrate gel in second-intention wound healing: a case report. J Med Case Rep 2021;15:85.
Wang HC, Li Z, Li Z, et al. Platelet-rich plasma combined fat transplantation for the treatment of bleomycin-induced murine scleroderma. Ann Plast Surg 2023;90:626-30.
Daumas A, Magalon J, Delaunay F, et al. Fat grafting for treatment of facial scleroderma. Clin Plast Surg 2020;47:155-63.
Serratrice N, Bruzzese L, Magalon J, et al. New fat-derived products for treating skin-induced lesions of scleroderma in nude mice. Stem Cell Res Ther 2014;5:138.
Macko RF, Gelber AC, Young BA, et al. Increased circulating concentrations of the counteradhesive proteins SPARC and thrombospondin-1 in systemic sclerosis (scleroderma). Relationship to platelet and endothelial cell activation. J Rheumatol 2002;29:2565-70.
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