Cutaneous manifestations of lupus, especially chronic lupus erythematosus, are a source of significant morbidity and can negatively impact the patient's quality of life. While the active inflammatory component of the disease can be adequately treated, patients are often left with residual skin damage and aesthetic impairment. Dermatologists lack guidelines regarding the use and safety of various reconstructive and cosmetic interventions for this patient population. In the article on estet-portal.com you will learn about the results of cosmetic interventions in patients with systemic lupus erythematosus.
- Systemic lupus erythematosus: background data on cosmetic procedures
- The use of laser technologies for patients diagnosed with systemic lupus erythematosus
- Is it possible to resort to injection procedures when diagnosed with systemic lupus erythematosus?
- Conclusion
Systemic lupus erythematosus: background data on cosmetic procedures
Laser therapy is largely avoided in people with lupus due to the potential for ultraviolet and visible light photodamage. Likewise, given the autoimmune nature of this disease, some clinicians avoid injection treatments and transplants for fear of reactivation of the disease through antigenic stimulation.
In the past, the use of laser therapy in patients with lupus erythematosus has been controversial given the photosensitive nature of the disease.
Read also: Principles of diagnosis and treatment of systemic lupus erythematosus.
The combination of photoprotection, medical support with topical immunomodulators and antimalarials remains the first line of treatment for skin manifestations lupus erythematosus.
The use of laser technologies for patients diagnosed with systemic lupus erythematosus
Despite the above facts, recently there have been quite a lot of trials and randomized clinical trials that have shown excellent results in the use of lasers for the treatment of erythema associated with lupus erythematosus during the active period, as well as for the treatment of hyperpigmentation and scarring during the inactive period of the disease.
Discoid lesions of lupus erythematosus are difficult to treat because these lesions include telangiectasia, hyperpigmentation, and scarring. The combination of IPL and Q-switch neodymium laser (Nd:YAG) is reported to be well tolerated for the treatment of patients with active discoid lesions. Considering the fact that IPL technology targets more superficial telangiectasia, and Nd:YAG neodymium laser targets dermal melanosomes, the combination of these two methods works well on aesthetic problems in patients with systemic lupus erythematosus.
Read also: Skin therapy for systemic lupus erythematosus.
Nd:YAG is a non-ablative laser that induces the formation of dermal collagen while reducing the potential risk of epidermal wounds.
Erbium yttrium aluminum garnet, Er:YAG, laser is also widely used to treat discoid cicatricial lupus.
The ablative laser modality of these lasers sacrifices the efficiency of dermal collagen production to reduce tissue damage and healing time compared to CO2 ablative lasers.
In addition, argon lasers (non-ablative) have been used to treat erythematous, hyperkeratotic plaques and telangiectasias during active disease, with subjective resolution of the lesions and no scarring or pigmentary changes within 6 months. Previously, argon lasers were used extensively to treat vascular and pigmented lesions, but the advantage of selective thermolysis and thus reduction of scarring and pigmentary changes seen in newer pulsed dye lasers (PDLs) has led to a decline in the use of argon (non-ablative) lasers.
IPL technology has been successfully used in the treatment of chronic facial erythema and burning associated with a diagnosis of systemic lupus erythematosus.
In addition to IPL, several studies have shown that the use of low-frequency PDL is well tolerated in treating the vascular component of skin lesions in lupus patients and also inhibits the migration of inflammatory cells.
Evidence of a decrease in inflammatory cells and their migration is confirmed by histopathological patient biopsy results.
Is it possible to resort to injection procedures when diagnosed with systemic lupus erythematosus?
Injection procedures are not performed for patients with lupus erythematosus, as for patients with other systemic inflammatory diseases, due to the theoretical risk of exacerbation or reactivation of the disease caused by tissue stimulation.
Recently, more and more positive results have been achieved using injection techniques to correct atrophic lesions in lupus erythematosus.
Hyaluronic acid, poly-L lactic acid, polyacrylamide hydrogel showed subjective satisfactory results without adverse reactions or exacerbation of the disease for patients with lupus erythematosus. Documented side effects include edema, transient erythema, ecchymosis, hematoma, tenderness, inflammatory masses, and granulomas.
Enzyme hyaluronidase in cosmetology.
Side effects in the form of nodules mainly appeared when using fillers with low molecular weight hyaluronic acid; several sessions of injections of hyaluronidase and triamcinolone were required to resolve these nodules. Patients observed the first signs of nodules a year or more later.
To prevent complications, all injection procedures should be carried out during the period of remission and in the absence of any drug treatment, such as taking immunosuppressants.
It is assumed that invasive surgical procedures in patients with lupus erythematosus are more likely to lead to complications such as disease relapse, hypercoagulability and reduced regeneration due to the use of immunosuppressants. Systemic manifestations from other organs and systems are also possible. If a decision is made about reconstructive surgery, the use of implants increases the risks of complications and increases the risk of complications, it is preferable to use patient's autologous fat.
Conclusion
There is a need for reconstructive interventions in the population with systemic lupus erythematosus, but due to potential complications, specialists often refuse to provide services to such patients. To prevent complications, the specialist should collect a detailed medical history and warn the patient about the consequences.
At this time, research is still underway to provide comprehensive information and develop guidelines for professionals working with patients diagnosed with systemic lupus erythematosus.
Article source: JAAD .
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