Hyaluronic Acid Filler Injection in Localized Scleroderma With Facial Atrophies

Stable localized scleroderma with facial atrophies can be treated efficaciously with minimally invasive hyaluronic acid filler resulting in minimal downtime, according to study findings published in Clinical, Cosmetic and Investigational Dermatology.

Therapeutic options for localized scleroderma (morphea), include imiquimod, mycophenolate mofetil, CO₂ fractional laser treatment, oral or subcutaneous methotrexate, tacrolimus, medium-dose UVA1 phototherapy, calcipotriol, and corticosteroids. It was noted that patient disfigurement rate is about 50% and surgical options result in varying success. The researcher sought to show hyaluronic acid fillers could be an efficacious treatment of stable localized morphea with facial disfigurement.

The researcher reviewed a case report of a woman, 35 years of age, with stable localized scleroderma and an atrophic scar on her face extending from the right labio-mental crease to the chin midline. The patient had been diagnosed with localized scleroderma and treated for 2 years until the active disease resolved, leaving the atrophic scar. Facial disfigurement was described by the loss of chin contour. The patient was a healthy nonsmoker without comorbidities and no history of herpes simplex infection. She was not on oral or topical medication for morphea at the time of referral. The atrophy area was asymptomatic, and the scar was indurated, uneven, and hyperpigmented. The patient reported no difficulties in every-day related activities of speaking, swallowing, eating, or opening her mouth.

The referring dermatologist had treated with systemic corticosteroids for 3 months and oral methotrexate for a year resulting in stable disease for 3 years.

The researcher reported that treatment of the atrophic scar included 2 hyaluronic acid fillers with the same cross-linking polymer but different G primes — this resulted in an “excellent cosmetic outcome” with no side effects. Patient follow-up occurred at 6 months and 1 year after treatment. The filler was retained with no deterioration in effect. The skin was smooth, and other than a mild postinflammatory hyperpigmentation, the deformity was barely visible. There was no suggestion of disease reactivation at the 1-year follow-up.

The researcher concluded that, “Hyaluronic acid filler can be used safely in cases of stable localized scleroderma with facial atrophies.” They noted this is a minimally invasive, effective treatment with limited downtime. The researcher underscored the importance that only stable cases of localized morphea be injected with fillers. They added that, “Apart from filling the defect, hyaluronic acid is also known to have bio-stimulatory effects leading to neocollagenesis.” According to the researcher, this patient saw no exacerbation or reactivation of the disease for up to 2 years, but treatment outcome will vary with the patient.

Reference

Sharad J. Hyaluronic acid filler injection for localized scleroderma – case report and review of literature on filler injections for localized scleroderma. Clin Cosmet Investig Dermatol. Published online August 11, 2022. doi:10.2147/CCID.S356641