Hyaluronic acid‐based fillers in patients with autoimmune inflammatory diseases

Abstract

The use of hyaluronic acid (HA)‐based aesthetic therapies is growing steadily, and according to the International Society of Aesthetic Plastic Surgery, more than 4.3 million aesthetic procedures using HA were performed in 2019, an increase of 15.7% than 2018. More people are offering these types of services, often without proper training or qualifications. Therefore, there is an increasing number of reports in the literature relating to possible adverse events, with subsequent therapeutic problems and more or less serious consequences for patients. The aim of this research is to carry out a review of the literature in order to evaluate the impact of hyaluronic acid‐based fillers in patients with autoimmune inflammatory diseases, in particular scleroderma and Systemic Lupus Erythematosus (SLE). Although HA plays a central role in the inflammatory process, the use of HA‐based fillers in patients with autoimmune inflammatory diseases is still controversial. HA, in fact, in inflamed tissues helps to propagate the inflammatory response and, injected in the form of a dermal filler, could potentially promote reactivation of the underlying disease. For this reason, many specialists do not perform HA‐based aesthetic treatments in patients with scleroderma or SLE. However, recent scientific evidence suggests that the use of HA‐based fillers in patients with scleroderma can lead to improvement of skin lesions, with satisfactory results. In the literature, there are no clinical studies that contraindicate the administration of HA‐based dermal fillers in patients with inflammatory disease.

18F-FDG PET-CT Scans in Oncology Patients Treated with Hyaluronic Acid Filler: Not Always a Pitfall

“…Specifically, granulomatous reactions occur between 0.04 and 0.3% of filler injection cases, with immunotherapy being identified as a risk factor for their occurrence. Checkpoint inhibitors appear to act as a trigger for the formation of foreign bodies against fillers, also many years after HA injection [ 8 ]. Conversely.…”

“…Thanks to their biocompatibility and low immunogenicity, HA fillers are potentially suitable even in patients with immune system dysregulation or those undergoing immunotherapy. However, due to the slightly increased risk of hypersensitivity reactions in these patient categories, and the absence of extensive clinical studies exploring the interaction between HA fillers and the immune system, many specialists do not perform HA-based aesthetic treatments in patients with an overactive immune system [ 8 ]. Treatment choices need to be safe and compatible with ongoing anticancer therapies and not compromise oncologic outcomes.…”

Intradermal Injection of Hybrid Complexes of High- and Low-Molecular-Weight Hyaluronan: Where Do We Stand and Where Are We Headed in Regenerative Medicine?

“…Although HA plays a central role in the inflammatory process, the use of HA-based fillers has shown significant clinical and cosmetic advantages in lupus and scleroderma patients under treatment. They also have a strong safety record and might potentially be a novel therapeutic option for patients with systemic scleroderma when combined with PEP [ 28 ]. However, HA-based fillers still present some limitations, such as the use of chemical cross-linking reagents and the maximum concentration of HA used for this product (25 mg/mL).…”

Selected aesthetic medicine treatment in patients with autoimmune diseases - a literature review

“…Jednak żadne badania kliniczne nie określiły przeciwwskazań do podawania wypełniaczy skórnych na bazie HA u pacjentów z chorobą zapalną. Wypełniacze na bazie HA w rzeczywistości nie tylko wykazały z dobrym profilem bezpieczeństwa istotne korzyści kliniczne i estetyczne u leczonych pacjentów z twardziną skóry lub toczniem, ale także mogłyby stanowić, w połączeniu z osoczem wzbogaconym w płytki krwi, nową strategię terapeutyczną dla pacjentów z twardziną układową, chociaż wyniki te wymagają potwierdzenia przez większą grupę pacjentów [14]. Ostatnie dowody naukowe sugerują, że stosowanie wypełniaczy na bazie HA u pacjentów z twardziną skóry może prowadzić do poprawy zmian skórnych.…”