Novel use of poly‐L‐lactic acid filler for the treatment of facial cutaneous atrophy in patients with connective tissue disease

Abstract

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.

Morphea‐like discoid lupus erythematosus in a patient with a history of polyacrylamide gel injection: A case report

“…However, it is crucial for dermatologists to be caution because of the potential link between filler injection and autoimmune diseases, along with their potential long-term adverse effects. 13 In our case report, it is important to note that we do not have enough evidence to establish a direct relationship between the use of PAAG filler or the drainage process and the development of DLE. This limitation should be taken into consideration when interpreting the findings.…”

“…As there is a concern about flare‐ups of these diseases following cosmetic procedures, the patients in the study were followed up for approximately 2 years and did not experience any adverse effects or disease reactivation. However, it is crucial for dermatologists to be caution because of the potential link between filler injection and autoimmune diseases, along with their potential long‐term adverse effects 13 …”

Sculptra®—History and how it is best used today

“…Historically, the use of soft tissue fillers in patients with CTD has been limited due to the theoretical risk of disease exacerbation or reactivation. Nonetheless, some authors assert that available evidence to date, while limited, does not support this risk in patients whose disease is well controlled at the time of treatment 24,25 . Sculptra®—as a single regimen or adjuvant in combined modalities—has been used in numerous cases of Perry‐Romberg Syndrome and facial linear scleroderma, with subjective improvements reported 26,27 .…”

“…Nonetheless, some authors assert that available evidence to date, while limited, does not support this risk in patients whose disease is well controlled at the time of treatment. 24,25 Sculptra ® -as a single regimen or adjuvant in combined modalities-has been used in numerous cases of Perry-Romberg Syndrome and facial linear scleroderma, with subjective improvements reported. 26,27 A handful of cases also describe successful use for facial lipoatrophy in patients with quiescent scleroderma, CREST syndrome, 25 and lupus erythematosus panniculitis, 28,29 with no reactivation or worsening of underlying disease observed during follow-up.…”