Di Toro Giuseppe, Alito Angelo, Leonardi Giulia, Di Toro Fiorenza Giulia, Portaro Simona
Università Popolare Accademia Internazionale di Nutrizione Clinica, Roma, Italy.
Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
J Scleroderma Relat Disord. 2025 May 15:23971983251341502. doi: 10.1177/23971983251341502.
Systemic sclerosis is a rare autoimmune disease characterized by progressive fibrosis, microvascular dysfunction, and chronic inflammation, leading to significant functional and aesthetic impairments, particularly in the face and hands. Current therapeutic strategies are limited in their ability to reverse established skin fibrosis, prompting interest in regenerative approaches such as autologous fat grafting. Lipofilling and nanofat techniques, originally developed for volume restoration and skin rejuvenation, have demonstrated promising outcomes in improving skin texture, elasticity, and vascularization through mechanisms involving adipose-derived stem cells and stromal vascular fraction. This editorial reviews the available randomized controlled trials evaluating nanofat and lipofilling in the treatment of cutaneous manifestations of systemic sclerosis. A literature search identified four randomized controlled trials meeting inclusion criteria, primarily focused on facial fat grafting with or without platelet-rich plasma in corticosteroid-resistant patients. Although subjective improvements in skin quality were reported, methodological variability, small sample sizes, and non-standardized techniques limit the generalizability of findings. Given the autologous and minimally invasive nature of fat grafting, it represents a potentially valuable adjunct treatment for systemic sclerosis. However, further research, including multicenter registries and standardized protocols, is essential to better define its clinical utility and optimize outcomes in this complex disease.
系统性硬化症是一种罕见的自身免疫性疾病，其特征为进行性纤维化、微血管功能障碍和慢性炎症，会导致严重的功能和美观损害，尤其是在面部和手部。目前的治疗策略在逆转已形成的皮肤纤维化方面能力有限，这引发了人们对自体脂肪移植等再生方法的兴趣。脂肪填充和纳米脂肪技术最初是为了恢复容积和使皮肤年轻化而开发的，已通过涉及脂肪来源干细胞和基质血管成分的机制，在改善皮肤质地、弹性和血管化方面显示出有前景的结果。这篇社论综述了评估纳米脂肪和脂肪填充治疗系统性硬化症皮肤表现的现有随机对照试验。文献检索确定了四项符合纳入标准的随机对照试验，主要聚焦于在对皮质类固醇耐药的患者中进行面部脂肪移植（有无富血小板血浆）。尽管报告了皮肤质量的主观改善，但方法学的可变性、小样本量和未标准化的技术限制了研究结果的普遍性。鉴于脂肪移植的自体和微创性质，它是系统性硬化症一种潜在有价值的辅助治疗方法。然而，进一步的研究，包括多中心登记和标准化方案，对于更好地确定其临床效用并优化这种复杂疾病的治疗结果至关重要。
