Hyaluronidase Treatment of Scleroderma-Induced Microstomia

Hyaluronidase injections for treatment of symptomatic pansclerotic morphea-induced microstomia

“…One case report describes it to be mildly efficacious in treating radiation-induced morphea 7 . However, there are several reports on the use of hyaluronidase injections in another sclerosing disorder, SSc, also known as scleroderma 2, 8, 9. Hyaluronidase injections have been used to successfully treat decreased oral aperture, or microstomia, in the context of perioral involvement of SSc 2, 8.…”

“…However, there are several reports on the use of hyaluronidase injections in another sclerosing disorder, SSc, also known as scleroderma 2, 8, 9. Hyaluronidase injections have been used to successfully treat decreased oral aperture, or microstomia, in the context of perioral involvement of SSc 2, 8. Notably, Melvin et al 2 described hyaluronidase injections for a 53-year-old woman with limited cutaneous SSc and disabling microstomia despite treatment with mycophenolate mofetil and systemic corticosteroids.…”

“…Hyaluronidase injections have been used to successfully treat decreased oral aperture, or microstomia, in the context of perioral involvement of SSc 2, 8. Notably, Melvin et al 2 described hyaluronidase injections for a 53-year-old woman with limited cutaneous SSc and disabling microstomia despite treatment with mycophenolate mofetil and systemic corticosteroids. This patient, similar to ours, saw substantial improvement in her oral aperture with the injections 2 .…”

“…Management can be challenging, as unchecked disease activity can lead to severe sclerosis, resulting in functional impairment 1 . Sclerosis involving the face can lead to microstomia, leading to difficulties with mastication, phonation, and oral hygiene 2 …”

“…Mainstays of treatment include a combination of topical steroids, ultraviolet phototherapies (UVA-1 or UVB), and systemic immunosuppressive agents such as methotrexate or mycophenolate mofetil 1 . Most treatments are primarily aimed at reducing inflammation and are ineffective for sclerosis and resulting disability; however, off-label use of hyaluronidase has been reported to improve sclerosis in both morphea and other sclerosing disorders 2, 3, 4. We report on a patient with pansclerotic morphea involving the jawline and affecting the muscles of mastication, with resultant microstomia, who experienced notable improvement with hyaluronidase injections.…”