Additional Treatment for Digital Ulcers in Patients with Systemic Sclerosis: A Prospective, Open-Label, Multi-Arm Study for the use of Platelet-Rich Plasma-Lipofilling and Ultrasound-Based Treatments

Abstract

Background: Local treatments such as ultraviolet-A (UVA) phototherapy, topical calcitriol, injection of autologous fat grafting, Platelet-Rich Plasma (PRP), hyaluronic acid (HA) and local ultrasound (US) treatment are considered alternative approaches for skin involvement in Systemic sclerosis (SSc).The aim of our study was to evaluate the efficacy of PRP injection and lipofilling or local ultrasound in the treatment of SSc-related digital ulcers (DUs). Methods: We enrolled 28 patients with SSc. At baseline time (T0), all patients were treated with Iloprost intravenous infusions. Then, six patients (group 1) received a first inoculation of PRP, after 15 days a second inoculation of PRP and after 15 days a third of lipofilling. Other six patients (group 2) received the three consecutive injections associated with a maintenance therapy with additional injections of PRP every 30 days for 12 months. Six patients continued only the Iloprost therapy (controls). Ten patients (group 3) underwent medical sessions with ultrasound treatment for 10 days. Clinical evaluation was assessed at baseline, after 3 and 12 months of treatment for all patients.Results: In our study have shown an improvement in cutaneous and microvascular level, in quality of life, in mobility of extremities of upper limbs and a reduction of administration of Iloprost after PRP-Lipofilling and US treatment.Conclusions: Our findings suggest that PRP, coupled with lipofilling, and ultrasound treatment in SSc patients, can be considered additional procedures in the management of DUs.