BACKGROUND Dermal fillers such as hyaluronic acid, poly-l-lactic acid, and polymethyl-methacrylate are often used to treat cutaneous defects such as lipoatrophy. However, concern exists regarding their use in patients with a connective tissue disease (CTD) because of a theoretical risk of disease reactivation or exacerbation. Evidence regarding their use in patients with CTD also remains limited. OBJECTIVE This review intends to summarize and evaluate the available literature regarding the use of dermal fillers in patients with CTD. MATERIALS AND METHODS A literature search until May 2020 was conducted through PubMed, Ovid MEDLINE, and Ovid Embase to identify articles discussing the treatment of cutaneous defects secondary to CTD. Articles discussing the use of autologous fat transfer alone were excluded. RESULTS Twenty-three articles were reviewed. The amount of available evidence varies between the type of CTD and type of filler with morphea having the most published evidence out of the CTDs discussed and hyaluronic acid having the most published evidence out of the fillers discussed. Most studies demonstrated positive results with no report of disease reactivation or exacerbation. CONCLUSION Despite limited available evidence, dermal fillers seem to be safe as an adjunctive treatment for cutaneous defects in patients with CTD.

BACKGROUND Most patients with scleroderma suffer from microstomia, which can have debilitating consequences on their quality of life. Unfortunately, treatment options remain limited. No specific guidelines exist; hence, microstomia remains a challenge to treat in this patient population. OBJECTIVE This review aims to evaluate the different medical and surgical treatment modalities currently available for microstomia in patients with scleroderma and make recommendations for future research. MATERIALS AND METHODS A search of PubMed, Ovid MEDLINE, and Ovid Embase was conducted to identify articles discussing the treatment of microstomia in scleroderma. Twenty articles discussing surgical therapy and one article discussing medical therapy were reviewed. RESULTS Mostly because of a scarcity of high-level evidence, no individual therapy has documented long-term efficacy. Some treatments demonstrate positive results and warrant further research. CONCLUSION Given the variability of results, specific recommendations for the treatment of microstomia in patients with scleroderma are difficult to establish. A multifaceted approach that includes surgical and medical therapy is likely the best option to improve oral aperture in this patient population. Surgical treatments such as neurotoxins, autologous fat grafting, and ultraviolet A1 phototherapy may hold the most potential for improvement.

Patients suffering from connective tissue disease (CTD) often have facial cutaneous defects such as skin and fat atrophy with resultant facial asymmetry. 1 Concerns about provoking disease flare-up in conditions such as scleroderma, morphea, and lupus erythematosus panniculitis (LEP) make it difficult to decide when and what type of cosmetic procedures are safe in these patients. 2 Poly-L-lactic acid (PLLA) is a biodegradable, synthetic polymer that promotes endogenous collagen production. 3 Due to this property and its relative safety, injectable PLLA (brand name Sculptra) is used for soft tissue augmentation to treat facial lipoatrophy in patients with human immunodeficiency virus. 4 With respect to CTDs, PLLA has been used off-label to treat skin atrophy in patients with morphea, Parry-Romberg syndrome, and LEP. [4][5][6][7] We present a case series of three patients with various CTDs: one with LEP and to our knowledge the first reported cases of PLLA use in a patient with scleroderma and another with CREST syndrome who received PLLA injections for facial atrophy.

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