Are hyaluronic acid (HA) fillers a safe procedure in patients with autoimmune disorders?

From the Guidelines

Hyaluronic acid fillers can be considered safe for patients with autoimmune disorders, but caution and careful management are necessary to minimize potential risks and complications. Patients with autoimmune disorders should consult with both their rheumatologist and a dermatologist or plastic surgeon experienced in treating patients with autoimmunity before proceeding with the procedure. The decision to use hyaluronic acid fillers in patients with autoimmune disorders should be made on a case-by-case basis, taking into account the individual's specific condition, disease activity, and medical history 1.

Key Considerations

• The procedure may be performed during periods of disease stability rather than during flares, to reduce the risk of exacerbating the underlying autoimmune condition 2.
• Hyaluronic acid is naturally present in the body, which makes these fillers (brands like Juvederm, Restylane, and Belotero) less likely to trigger immune reactions compared to other filler types.
• However, the injection process itself can potentially trigger inflammatory responses in some autoimmune patients.
• Patients should disclose all medications, particularly immunosuppressants, as these may affect healing or increase infection risk.
• The procedure should be performed in a sterile environment by a qualified provider who understands autoimmune conditions.
• Some providers may recommend a small test injection to monitor for reactions before proceeding with full treatment.

Safety Profile

• The safety profile of hyaluronic acid fillers relates to hyaluronic acid's biocompatibility and the availability of hyaluronidase, an enzyme that can dissolve the filler if complications occur.
• According to a study published in the Annals of the Rheumatic Diseases, patients with pre-existing autoimmune diseases can be treated with cancer immunotherapy, and the occurrence of a flare or immune-related adverse event (irAE) is frequent but mostly manageable without discontinuation of therapy 1.
• Another study published in the Journal of the National Comprehensive Cancer Network found that immune checkpoint inhibitors (ICIs) can be effective in patients with pre-existing autoimmune diseases, but caution is necessary due to the potential for exacerbating the underlying autoimmune condition or triggering irAEs 2.

From the Research

Safety of Hyaluronic Acid Fillers in Patients with Autoimmune Disorders

• The use of hyaluronic acid (HA) fillers in patients with autoimmune diseases is a topic of interest due to the increasing incidence of autoimmune diseases and the growing demand for aesthetic treatments 3.
• Autoimmune diseases, such as Hashimoto's disease, scleroderma, and Systemic Lupus Erythematosus (SLE), may constitute a contraindication to HA filler treatments due to the risk of adverse side effects, especially those of immunological nature 3, 4.
• The incidence of adverse reactions after the use of HA-based fillers is estimated to be between 0.01-1%, with recurrent oedema and granulomas being the most typical reactions 3.
• However, some studies suggest that HA-based fillers can be safe and effective in patients with autoimmune diseases, such as scleroderma, and may even lead to improvement of skin lesions 4.
• The safety of HA fillers in patients with autoimmune disorders may depend on various factors, including the type of filler used, the patient's medical history, and the practitioner's expertise 5, 6.

Risk Factors and Prevention

• Patient-related risk factors for late-onset reactions (LORs) after HA filler injections include recent dental treatment, current medical status, and active autoimmune disease 6.
• Product-related risk factors include the molecular weight of the HA filler, while procedure-related risk factors include aseptic technique and trauma 6.
• To reduce the risk of LORs, practitioners should maintain an effective aseptic technique, choose an appropriate product and injection depth, and provide patients with education on proper filler care 6.

Management of Adverse Reactions

• The management of LORs depends on the suspected etiology, and may include hyaluronidase, watchful waiting, steroid treatment, or antibiotic treatment 6.
• A retrospective analysis of medical records and histopathological examinations found that Neauvia Stimulate, a HA filler cross-linked with polyethylene glycol, was safe and effective in patients with Hashimoto's disease, with no alarming symptoms or effects on antibody levels 7.