Hyaluronic acid lip fillers safe for patients with systemic sclerosis, study finds

Thin lips are not only a common cosmetic concern in patients with scleroderma, a condition that involves tightening and hardening of the skin among other effects on internal organs, but also can impact a person's ability to chew, swallow, and sleep.

In addition, the condition can be stigmatizing and have significant psychosocial impacts. Although hyaluronic acid fillers are commonly used in the restoration of lip volume, they have not been used routinely in patients with the disease due to concerns of worsening the autoimmune condition.

Researchers in Yale's Department of Dermatology and Internal Medicine's Section of Rheumatology, Allergy and Immunology conducted a prospective study of seven patients with systemic sclerosis and perioral involvement to evaluate the safety and efficacy of these fillers in this patient population.

They published their findings in JAAD Case Reports in a paper titled "Hyaluronic acid filler for lip augmentation in patients with systemic sclerosis: A prospective cohort study."

Among the various types of cosmetic lip filler, the team chose Restylane Silk (Galderma) a hyaluronic acid filler with low cross-linking, hypothesized to have lower immunogenicity.

Patients' baseline and post-treatment lip fullness were evaluated based on photographs before and immediately following filler treatment. Dermatologists and patients also completed the Investigator Global Aesthetic Improvement Scale and Subject Global Aesthetic Improvement Scale, respectively, in which one indicated "very much improved" and five indicated "worse than the original condition."

Results of the study found a statistically significant increase in the difference between pre- and post-injection fullness in both upper and lower lips across the study population. Additionally, the mean post-treatment score fell between "much improved" (two) and "improved" (three) on both the Investigator Global Aesthetic Improvement Scale and the Subject Global Aesthetic Improvement Scale.

Overall, the study indicated that hyaluronic acid fillers were safe and effective for patients with scleroderma, demonstrating improved appearance of thin lips and high patient satisfaction. Ongoing work will assess changes in mastication and sleep quality. The authors also observed anecdotally that more frequent treatment may be needed for scleroderma patients due to more quickly diminishing filler.

The study was directed by Kathleen Suozzi, MD, associate professor of dermatology, and Monique Hinchcliff, MD, MS, associate professor of medicine (rheumatology, allergy & immunology) and director of the Yale Scleroderma Program.