What is Scleroderma?.

Scleroderma (or Systemic Sclerosis) is a chronic inflammatory disease of autoimmune origin characterized by the presence of progressive sclerosis or fibrosis and disseminated vascular injuries that affects (or may affect) the skin and internal organs.

It is a rare disease with a prevalence of between 50 – 300 cases per million inhabitants. Very rare in children, Scleroderma usually appears in patients between 45 to 60 years of age. Women suffer from scleroderma more frequently than men (14: 1) and black individuals appear to have greater susceptibility and more aggressive evolutions.

Raynaud’s phenomenon (the whitening and/or bruising of the fingertips in response to cold or stress) is usually the initial manifestation of Scleroderma. Later, the rest of the signs and symptoms can appear quickly or take years, and be more or less noticeable.

Common initial signs of developing scleroderma are thickening of the skin (especially on the face and hands), the appearance of spider veins in the naifolds, or thinning of the fingertips.

The long-term evolution of Scleroderma can be very variable, from mild cases with little skin involvement to severe cases with generalized skin involvement of hands and face, disfigurement and loss of mobility. Two main groups are usually differentiated:

• Limited cutaneous scleroderma: A condition limited to the skin with loss of fat, atrophy and fibrosis of the skin of hands, face and arms, in addition to Raynaud’s phenomenon.
• Diffuse cutaneous scleroderma: Serious conditions with general involvement of the body skin, involvement of the heart, esophagus, kidneys or lungs.

Why Scleroderma appears?.

The exact origin of Scleroderma is almos unknown. The presence of various types of autoantibodies and the release of great amounts of free radicals appear to be fundamental factors. During the initial development of the disease there is inflammation and damage to the blood capillaries (also known as vasculitis), which is linked to a defect in the production of new blood vessels. From this first inflammatory phase, the affected tissues usually suffer progressive atrophy and fibrosis (a kind of excesive «scarring») as well as profound changes in their structure.

Treatment of skin involvement caused by Scleroderma.

Scleroderma, in its different forms, does not have a curative treatment and there is no single drug or group of drugs that controls all manifestations.

Localized skin involvement in Scleroderma patients usually don’t  benefit from medical treatments such as immunomodulators.

Some cases in their initial inflammatory phase treated with immunosuppressants (such as Methotrexate or Cyclophosphamide) show a slight improvement, but several studies show that immunosuppressants are not useful in patients with fibrosis.

Regenerative medicine approach for the treatment of Scleroderma.

The use that Dr. Monreal makes of Regenerative Medicine for the treatment of Scleroderma is mainly focused on the improvement of disfiguring lesions of the face, hands and fingers. Skin tightness can be mild or quite severe and can influence how and how much fat product can be injected. So depending on the degree and severity of involvement this kind of treatment should be repeated more than once.

The benefits that fat grafting (and other fat «products») have on tissue damage caused by fibrosis and other problems of the skin and nearby structures has been known for decades. Fat grafting is well known for its anti-fibrotic and pro-angiogenic properties (which promote the development of new blood vessels) and have been used by Dr. Monreal in the treatment of other illnesses such as lichen sclerosus, congenital muscular torticollis or radiotherapy side effects.

• Facial deformity of patients with Scleroderma can be aesthetically and functionally improved through the use of adipose tissue (fat) of the patient.
  The use of enriched fat grafting improves the texture, elasticity and general mobility of the lips and mouth of patients with Scleroderma.
  The use of enriched fat grafting also improves the elasticity, texture and appearance of other facial areas such as the cheeks, cheekbones,  or nose. Facial mobility improves, as well as the appearance of the skin and its thickness.
• Deformity and functionality of the hands and fingers in patients with Scleroderma can be improved through the use of enriched fat grafting. In this case, the product to be injected must be especially «liquid» in order to be adequately infiltrated.

In summary, Regenerative Medicine and utilization of enriched fat grafting are a useful alternative in the treatment of patients with skin involvement caused by Scleroderma.

To learn more about the fundamentals of Regenerative Medicine see this link (in Spanish with online translation).
To find out how Dr. Monreal performs these treatments, see this link (in Spanish with online translation).

Additional Information

Click here if you want to read more about Dr. Juan Monreal and access some of his published articles.

You can use the search field below to perform a PubMed search.

You can find more information about regenerative medicine in the following selected articles.

• Safety and Efficacy of Stromal Vascular Fraction Enriched Fat Grafting Therapy for Vulvar Lichen Sclerosus.
• Treatment of linear scleroderma “En coup de Sabre” with single‐stage autologous fat grafting: A case report and review of the literature.
• Autologous Fat Grafting for Scleroderma-Induced Digital Ulcers. An Effective Technique in Patients with Systemic Sclerosis.
• Autologous Fat Grafting in the Treatment of Facial Scleroderma