{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:06:37Z","timestamp":1788948397927,"version":"build-2803163510"},"reference-count":73,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/igo\/"}],"funder":[{"name":"NIH\/NIAMS","award":["R01 AR081382-01A1"],"award-info":[{"award-number":["R01 AR081382-01A1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Scleroderma Relat Disord"],"accepted":{"date-parts":[[2025,11,8]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    Systemic sclerosis (SSc), or scleroderma, is a chronic autoimmune disease marked by excessive collagen deposition and vasculopathy. Orofacial manifestations of SSc, particularly involving the lips, are common including microcheilia, microstomia and the classic \u2018mask-like\u2019 face, all of which greatly affect patient quality of life. This review explores the lips in both health and SSc. We examine factors affecting lip health, methods of assessment, SSc-specific impacts and discuss available therapeutic approaches.\n                    <jats:named-content content-type=\"\">A comprehensive literature search was conducted via PubMed and Embase. All article types were considered from inception of the databases<\/jats:named-content>\n                    <jats:named-content content-type=\"\">and the search was last run on<\/jats:named-content>\n                    20\n                    <jats:named-content content-type=\"\">April<\/jats:named-content>\n                    2025\n                    <jats:named-content content-type=\"\">.<\/jats:named-content>\n                    The lips play a critical role in facial expression, communication and appearance. Anatomy is complex and relevant to SSc pathogenesis. Relevant factors include gender differences, ageing patterns, ethnicity and lifestyle. The pathogenesis of lip involvement in SSc is multifactorial. In SSc, dermal fillers, autologous fat transfer and platelet-rich plasma therapy have been shown to at least transiently volumise the lips and alleviate tightness. There is a lack of data on long-term benefits as well as standardised assessment tools for lip involvement in SSc.\n                    <jats:named-content content-type=\"\">The impact of lip involvement in SSc presents significant unmet clinical needs. There is a critical need to benchmark natural lip variation due to ethnicity,<\/jats:named-content>\n                    ageing\n                    <jats:named-content content-type=\"\">and gender to facilitate research. Future research agendas should focus on defining<\/jats:named-content>\n                    patient\n                    <jats:named-content content-type=\"\">priorities,<\/jats:named-content>\n                    standardising\n                    <jats:named-content content-type=\"\">imaging techniques to assist in understanding pathogenesis and treatment response, and developing evidence<\/jats:named-content>\n                    <jats:named-content content-type=\"\">based educational resources for<\/jats:named-content>\n                    patients\n                    <jats:named-content content-type=\"\">and healthcare<\/jats:named-content>\n                    <jats:named-content content-type=\"\">professionals<\/jats:named-content>\n                    <jats:named-content content-type=\"\">.<\/jats:named-content>\n                  <\/jats:p>","DOI":"10.1136\/jsrd-2026-000004","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:50:27Z","timestamp":1779803427000},"page":"e000004","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Lips in health and in systemic sclerosis: relevant physiology, pathogenesis, existing therapeutic approaches and unmet needs"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6537-5213","authenticated-orcid":false,"given":"Mustafa","family":"Mahmood","sequence":"first","affiliation":[{"name":"Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hughes","sequence":"additional","affiliation":[{"name":"Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester academic Health Science Centre, Manchester, UK"},{"name":"Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"},{"name":"NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsuzsanna H","family":"McMahan","sequence":"additional","affiliation":[{"name":"Rheumatology, UTHealth, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Albany Medical College, Albany, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"2026090902101076000_11.1.e000004.1","first-page":"322","article-title":"Orofacial manifestations of scleroderma. 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