Hyaluronic acid lip fillers safe for MS patients, study finds

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

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

Researchers in the Division of Rheumatology, Allergy, and Immunology at the Yale Department of Dermatology and Internal Medicine 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.

These published their findings in JAAD Case Reports in a paper entitled “Hyaluronic acid filler for lip augmentation in patients with systemic sclerosis: A prospective cohort study.”

Among various types of cosmetic lip fillers, the team chose Restylane Silk (Galderma) a low-crosslinking hyaluronic acid filler, which is supposed to have lower immunogenicity.

Baseline and post-treatment lip fullness of patients were assessed based on photographs before and immediately after filler treatment. Dermatologists and patients also completed the Investigator’s Global Aesthetic Improvement Scale and the Subject’s Global Aesthetic Improvement Scale, respectively, in which one indicated “much improved” and five “worse than baseline.”

The study results found a statistically significant increase in the difference between pre- and post-injection fullness in both the upper and lower lip in the study population. In addition, the mean post-treatment score fell between “much improved” (two) and “improved” (three) on both the Investigator’s Global Aesthetic Improvement Scale and the Subject’s Global Aesthetic Improvement Scale.

Overall, the study showed that hyaluronic acid fillers were safe and effective for patients with scleroderma, demonstrating an improved appearance of thin lips and high patient satisfaction. Ongoing work will assess changes in chewing and sleep quality. The authors also noted anecdotally that more frequent treatment may be required for patients with scleroderma due to faster filler depletion.

The study was led 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.