Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with lupus erythematosus

J Am Acad Dermatol. 2020 Aug;83(2):343-363. doi: 10.1016/j.jaad.2020.03.123. Epub 2020 Apr 28.

Abstract

The cutaneous manifestations of lupus, especially chronic cutaneous lupus erythematosus, are a source of significant morbidity and can negatively impact patient quality of life. While the active inflammatory component of the disease may be adequately treated, patients are frequently left with residual skin damage and disfiguring aesthetic deficits. Dermatologists lack guidelines regarding the use and safety of various reconstructive and cosmetic interventions in this patient population. Laser treatments are largely avoided in the lupus population because of the possible photodamaging effects of ultraviolet and visible light. Similarly, given the autoimmune nature of this disease, some physicians avoid injectable treatment and grafts because of the concern for disease reactivation via antigenic stimulation. In the second article in this continuing medical education series we compile available data on this topic with the goal of providing evidence-based guidance on the cosmetic treatment of patients with lupus erythematosus with a focus on chronic cutaneous lupus erythematosus.

Keywords: calcium hydroxylapatite; fat transfer; hyaluronic acid; injectables; intense pulsed light; laser treatment; lipoinjection; lupus; mental health; poly-L-lactic acid; polymethylmethacrylate; pulsed dye laser; quality of life.

Publication types

  • Review

MeSH terms

  • Cosmetic Techniques / instrumentation
  • Cosmetic Techniques / standards*
  • Dermal Fillers / administration & dosage
  • Dermal Fillers / adverse effects
  • Dermatology / instrumentation
  • Dermatology / methods
  • Dermatology / standards*
  • Esthetics
  • Evidence-Based Medicine / instrumentation
  • Evidence-Based Medicine / methods
  • Evidence-Based Medicine / standards
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lasers, Solid-State / therapeutic use
  • Lupus Erythematosus, Discoid / complications
  • Lupus Erythematosus, Discoid / immunology
  • Lupus Erythematosus, Discoid / therapy*
  • Practice Guidelines as Topic*
  • Professional Practice Gaps
  • Quality of Life
  • Skin / drug effects
  • Skin / immunology
  • Skin / radiation effects
  • Treatment Outcome

Substances

  • Dermal Fillers
  • Immunosuppressive Agents