Is it safe to administer Radiesse (calcium hydroxylapatite) filler in a patient receiving Skyrizi (risankizumab), and what timing considerations are recommended?

Radiesse and Skyrizi: Safety and Timing Considerations

Radiesse (calcium hydroxylapatite) can be safely administered in patients receiving Skyrizi (risankizumab), as there are no documented contraindications or drug interactions between dermal fillers and IL-23 inhibitors.

Key Clinical Considerations

No Direct Contraindications

The available evidence shows no specific warnings against combining cosmetic dermal fillers with biologic immunosuppressants like Skyrizi. The FDA label for Skyrizi 1 does not list dermal filler procedures as contraindications, and the AAD-NPF guidelines for biologics 2 do not address cosmetic procedures as requiring special precautions beyond surgical considerations.

Theoretical Immunosuppression Concerns

While Skyrizi is an IL-23 inhibitor that modulates immune function, the primary safety concerns relate to:

• Infection risk: The guidelines recommend caution with procedures that break skin barriers 2
• Wound healing: Surgical procedures may require timing adjustments around biologic dosing 2

However, dermal filler injections are minimally invasive and do not fall into the moderate-to-high risk surgical categories that warrant biologic discontinuation.

Practical Recommendations

Timing Strategy

• No need to hold Skyrizi for Radiesse injection
• Perform the procedure using standard sterile technique
• Consider scheduling between Skyrizi doses (given every 12 weeks for psoriasis/PsA 1) if you want maximum immune function, though this is not evidence-based

Infection Prevention

• Use meticulous aseptic technique during injection
• Avoid injecting through active psoriatic plaques or inflamed skin 1
• Monitor for signs of infection post-procedure, as patients on biologics may have slightly altered immune responses 2

Radiesse-Specific Safety Profile

Radiesse has demonstrated excellent long-term safety 3:

• Only 3% adverse event rate in large studies 4
• Most common complication is nodule formation (96% of adverse events), typically self-resolving 4
• No reports of increased infection risk in immunosuppressed populations specifically, though HIV-associated lipoatrophy is an FDA-approved indication 5, 6

Common Pitfalls to Avoid

1. Don't unnecessarily discontinue Skyrizi: The guidelines only recommend holding biologics 3-4 half-lives before moderate-to-high risk surgery 2. Dermal filler injection is not in this category.

2. Don't inject through diseased skin: Avoid areas with active psoriatic lesions or inflammation 1

3. Don't assume all procedures require the same precautions: Low-risk procedures (those without entering body cavities and maintaining sterile technique) can proceed without biologic interruption 2

Patient Counseling

Inform patients that:

• The combination has no documented safety concerns
• Standard filler risks apply (bruising, swelling, nodules)
• They should report any signs of infection promptly given their immunomodulatory therapy
• Radiesse effects can last 12+ months with good safety profile 3, 7