Hyaluronic acid fillers in systemic sclerosis and localized scleroderma: A systematic review

INTRODUCTION: Patients with systemic sclerosis (SSc) or morphea increasingly inquire about cosmetic procedures, as these conditions often result in disfiguring cutaneous manifestations such as microstomia, thin lips, sclerotic plaques or skin atrophy. Traditionally, rheumatologists prioritize immunosuppression and disease control but often fail to address aesthetic concerns. Among available interventions, hyaluronic acid (HA) fillers offer a minimally invasive approach, yet there is not enough information regarding efficacy and safety in this population. OBJECTIVE: This systematic review aims to discuss current evidence regarding the use of HA fillers in patients with SSc or morphea. METHODS: A literature search was conducted in PubMed, CENTRAL and clinicaltrials.gov from inception until January 2025. Two independent reviewers examined the studies and extracted data. Data regarding the number of patients, disease type, HA filler particulars, technique, additional treatments, immunosuppression, patient reported or other outcomes and follow-up were extracted. RESULTS: Nineteen studies met the inclusion criteria, consisting of 8 case reports, 7 case series and 4 prospective interventional studies (including one controlled study). Most common areas were the forehead, chin and perioral region. Some studies used adjuvant treatments such as Botox or Platelet-Rich Plasma (PRP). HA fillers were consistently associated with patient satisfaction and good cosmetic results. In patients with SSc, mouth opening improved and microstomia was alleviated. However, one controlled study reported no significant improvement in mouth opening compared to autologous fat grafting. Inactive morphea lesions appeared to be more responsive compared to inflammatory ones. Adverse events were mild with no reports of disease flare. CONCLUSION: HA fillers appear to be a safe and minimally invasive procedure for addressing both functional and aesthetic concerns of patients with SSc or morphea. Further randomized controlled trials are needed to clarify indications, durability and long-term safety.