Hyaluronic Acid-Based Products Are Strictly Contraindicated in Scleroderma-Related Skin Ulcers

Giulio Gualdi, MD; Paola Monari, MD; Daniele Cammalleri, MD; Laura Pelizzari, MD; Piergiacomo Calzavara Pinton, PhD


Wounds. 2019;31(3):81-84. 

In This Article


Even though within the authors' dermatology practice sclerodermic ulcers represent about 2% of total patients followed for skin ulcers, the particular pathogenesis of the disease and several comorbidities associated implicated a large expenditure of energy in terms of time consulting with the patient, selecting the appropriate wound treatment, and coordinating systemic therapy (prostanoid, endothelin receptor antagonist, immunosuppressant agent). As evident by the data herein, if used on vascular deficiency ulcers (ie, venous, arterial, or mixed ulcers), HA is useful in aiding the wound healing process. However, broad-scale application without adequate medical screening of patients who are candidates for treatments with HA leads to an erroneous assessment of the effectiveness of the product. In this sense, the physician's role in the management of a cutaneous ulcer is to recognize the pathogenic mechanism leading to the formation and chronic nature of the same by selecting the most suitable local therapy in each individual case. Thus, despite that sclerodermic ulcers are limited in number, especially for the pathogenesis that underlies the disease, it is recommended not to use topical HA-based products for patients with scleroderma. It also is still unclear whether other types of ulcers of inflammatory etiology (autoimmune, pyoderma gangrenosum, vasculitis) can present the same contraindication. In this sense, additional case studies would be helpful.