Poly-l-Lactic Acid for Treating Facial Lipoatrophy Secondary to Lupus Erythematosus Panniculitis

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

“…1,9 With regard to PLLA filler, again only a few small studies have incorporated their use for CTDs, specifically in patients with morphea, LEP, Parry-Romberg syndrome, and rheumatoid arthritis (RA), and no published articles exist regarding their use in patients with scleroderma or CREST syndrome. [4][5][6][7]10 The most notable barrier toward more widespread use of fillers for treatment of CTD is theoretical concern for disease exacerbation or reactivation. 1,5,11 However, there is a growing body of evidence that these risks are largely theoretical in patients whose disease is well controlled at the time of treatment.…”

“…1,5,11 However, there is a growing body of evidence that these risks are largely theoretical in patients whose disease is well controlled at the time of treatment. 4,5,7,8 It is also unknown whether immunosuppressive medications may diminish response to PLLA as the mechanism of action is via an inflammatory reaction that promotes the endogenous production of collagen. 3 Of note, the previously mentioned articles discussing the use of HA fillers in scleroderma and the use of PLLA fillers in other CTDs showed no serious adverse effects to any patients aside from one patient with rheumatoid arthritis who developed severe ulcerations and multiple inflamed nodules on 12 months after receiving PLLA injections.…”

“…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.…”

Treatments for disease damage in cutaneous lupus erythematosus: A narrative review

“…Injectable fillers have been reported to improve the appearance of atrophic cutaneous lupus lesions (Table 3, Figure 2). Hyaluronic acid (HA), poly‐L‐lactic acid (PLLA), polymethylmethacrylate, and polyacrylamide fillers have all been reported to improve atrophy secondary to lupus panniculitis 1,34–39 . Filler is injected in the deep dermis or at the subdermal periosteal junction to improve contour.…”

“…Side effects of these fillers were minimal and included transient erythema, swelling, and bruising. Although there is a theoretical risk of reactivation of CLE as a result of antigenic stimulation as well as granuloma formation, there have been no known reports of this occurring in the literature 1,35–39 . All cases of filler injection for CLE lesions reported sustained improvement in atrophic lesions at follow up times ranging from one month to nine years.…”