Case Study

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Fallbericht über die Behandlung mit Poly-L-Milchsäure zur Linderung einer leichten persistierenden atopischen Dermatitis über einen Zeitraum von 62 Wochen

Case report of Poly-L-Lactic-Acid treatment improving mild persistent atopic dermatitis for 62 weeks

(NACH CARE-LEITLINIE)

Keywords | Summary | Correspondence | Literature

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Schlüsselworte

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Summary

Poly-L-lactic acid (PLLA-SCA) is used as a biostimulator for increasing the volume of depressed areas, particularly to correct skin depressions, such as skin wrinkles and folds as well as for skin aging [1]. It is also suitable for large volume corrections of the signs of facial lipoatrophy [2]. Recent data suggest that PLLA-SCA has anti-inflammatory and regenerative effects on the skin [3, 4, 5]. Here, we report the remission of mild, persistent lichenoid atopic dermatitis 45 weeks after PLLA-SCA treatment. Although more data are needed, we believe this report may provide the first indication of the potential application of biostimulators in improving mild inflammatory skin conditions.

Zusammenfassung

Poly-L-Milchsäure (PLLA-SCA) wird als Biostimulator zur Auffüllung von Volumendefiziten in eingefallenen Bereichen und insbesondere von Fältchen, Falten und Narben sowie zur Behandlung von Hautalterung [1]. Es eignet sich auch für die Korrektur von großen Volumendefekten durch Lipoatrophie im Gesicht [2]. Jüngste Daten deuten darauf hin, dass PLLA-SCA eine entzündungshemmende und regenerative Wirkung auf die Haut hat [3, 4, 5]. Im Folgenden beschreiben wir die Remission einer leichten, persistierenden lichenoiden atopischen Dermatitis 45 Wochen nach der Behandlung mit PLLA-SCA. Obwohl es weiterer Studien bedarf, glauben wir, dass dieser Bericht den ersten Hinweis auf die potenzielle Anwendung von Biostimulatoren zur Verbesserung leichter entzündlicher Hauterkrankungen liefert.

Maja Waibel1, Stas Wüst2

 

  1. Privatpraxis für ästhetische Dermatologie, Berlin, DE
  2. Z282 Medical Affairs Consulting, Beverly, MA, USA

Poly-L-lactic acid (PLLA-SCA; Sculptra®, Galderma, Sweden) is an injectable biostimulator used to restore facial volume and improve skin wrinkles and signs of aging [1, 2, 6]. In 2019 Bohnert et al. and in 2024 Fabi and colleagues have shown that PLLA-SCA can significantly improve skin quality, including radiance and erythema, 12 months after three initial treatments [7, 8]. However, patients with eczema were excluded from the studies. To the best of our knowledge, no reports or clinical data investigating the effects of PLLA-SCA on eczema and skin quality exist.

 

We report the improvement of mild, persistent lichenoid atopic dermatitis on the left distal cheek and jawline in a 50-year-old woman following PLLA-SCA treatment.

Patient, Material and Methods
The patient has a history of atopic diathesis, type 1 allergies, atopic dermatitis in early childhood, and a positive family history. Atopic dermatitis resurfaced at the age of 47 years as mild, lichenoid and therapy-resistant lesions on the left distal cheek and jawline. No other lesions were reported. A contact dermatitis was ruled out. Over two years, the patient received multiple therapies, including mild topical steroids and calcineurin inhibitors. These included prednicarbate 0.25% cream, tacrolimus 0.1% cream, and pimecrolimus 0.1% cream. Each therapy provided temporary itch relief but failed to fully resolve the condition, with efficacy diminishing over several weeks. The atopic dermatitis fully resurfaced after each therapy. At age 49, the patient discontinued other therapies and used 0.1% prednisolone cream for itch relief during flare-ups.

 

At age 50, the patient underwent treatment with PLLA-SCA for wrinkle correction in the jawline, temples, and cheeks according to the instructions for use [1]. 2 vials of PLLA-SCA, reconstituted with 9 mL of Sterile Water for Injection (SWFI) and 1 mL of lidocaine, were used per session, with a total of three sessions, each approximately 6-8 weeks apart.

Aside from a regular skincare routine with a moisturizing cream, the patient did not use any topical or systemic treatments after the treatment.

Results and Discussion

31 weeks after the initial treatment, a reduction in lesions was observed, and at weeks 45 and 63, no atopic dermatitis lesions were detectable (Fig. 1). Additionally, improvement was noted in the nasolabial fold and overall skin quality, including smoothness and glow at weeks 45 and 63. At week 90 the patient was examined during a routine visit and remained symptom free.

Abb. 1: Patientin zu Studienbeginn, 31, 45 und 62 Wochen nach der
PLLA-SCA-Behandlung. Bereiche mit leichten milden und lokalen
atopischen Dermatitis-Läsionen sind mit einer gestrichelten Linie
eingekreist. In den Wochen 45 und 62 nach Studienbeginn wurden
keine Läsionen festgestellt.

To our knowledge this is the first report of a potential effect of PLLA-SCAs on mild atopic dermatitis and eczema in general. The primary mode of action for PLLA was described as a foreign body reaction [9, 10]. However, recent data suggest that PLLA acts anti-inflammatory on the molecular level and promotes tissue regeneration [3, 4, 5, 11, 12]. Although we cannot rule out other, individual factors that could contribute to the result, we strongly believe that PLLA-SCAs biostimulating and anti-inflammatory properties might be utilized for improvement of mild and local skin conditions in the future and encourage further clinical investigations of this topic.

Korrespondenz-Adresse

Dr. Stanislaus Wuest
Z282 Medical Affairs Consulting
132 Dodge St.
01915 Beverly, MA – USA

Konklusion

31 weeks after the initial treatment, a reduction in lesions was observed, and at weeks 45 and 63, no atopic dermatitis lesions were detectable (Fig. 1). Additionally, improvement was noted in the nasolabial fold and overall skin quality, including smoothness and glow at weeks 45 and 63. At week 90 the patient was examined during a routine visit and remained symptom free. To our knowledge this is the first report of a potential effect of PLLA-SCAs on mild atopic dermatitis and eczema in general. The primary mode of action for PLLA was described as a foreign body reaction [9, 10]. However, recent data suggest that PLLA acts anti-inflammatory on the molecular level and promotes tissue regeneration [3, 4, 5, 11, 12]. Although we cannot rule out other, individual factors that could contribute to the result, we strongly believe that PLLA-SCAs biostimulating and anti-inflammatory properties might be utilized for improvement of mild and local skin conditions in the future and encourage further clinical investigations of this topic.

Literatur

References: 1. Sculptra™ Information for Use, Q-Med AB, Seminariegatan 21, SE-752 28 Uppsala, Sweden; December 2020.
2. Duracinsky M, Leclercq P, Herrmann S, Christen MO, Dolivo M, Goujard C, Chassany O. Safety of poly-L-lactic acid (New-Fill®) in the treatment of facial lipoatrophy: a large observational study among HIV-positive patients. BMC Infect Dis., 2014 Sep 1;14:474. doi: 10.1186/1471-2334-14-474. PMID: 25178390; PMCID: PMC4160543.
3. Waibel J, Ziegler M, Nguyen TQ, Le JHTD, Qureshi A, Widgerow A, Meckfessel M. Comparative Bulk RNA-Seq Analysis of Poly-l-Lactic Acid Versus Calcium Hydroxylapatite Reveals a Novel,, Adipocyte-Mediated Regenerative Mechanism of Action Unique to PLLA. Dermatol Surg. 2024 Nov 1;50(11S):S166-S171. doi: 10.1097/DSS.0000000000004425. PMID: 39480040.
4. Waibel J, Nguyen TQ, Le JHTD, Qureshi A, Ziegler M, Widgerow A, Meckfessel M. Gene Analysis of Biostimulators: Poly-L-Lactic Acid Triggers Regeneration While Calcium Hydroxylapatite Induces Inflammation Upon Facial Injection., J Drugs Dermatol. 2025 Jan 1;24(1):34-40. doi: 10.36849/JDD.8464. PMID: 39761144.
5. Avelar LE, Nabhani S, Wüst S. Unveiling the Mechanism: Injectable Poly-L-Lactic Acid's Evolving Role-Insights From Recent Studies. J Cosmet Dermatol. 2024 Oct 16. doi: 10.1111/jocd.16635. Epub ahead of print. PMID: 39412038.
6. Narins RS, Baumann L, Brandt FS, Fagien S, Glazer S, Lowe NJ, Monheit GD, Rendon MI, Rohrich RJ, Werschler WP. A randomized study of the efficacy and safety of injectable poly-L-lactic acid versus human-based collagen implant in the treatment of, nasolabial fold wrinkles. J Am Acad Dermatol. 2010 Mar;62(3):448-62. doi: 10.1016/j.jaad.2009.07.040. PMID: 20159311.
7. Bohnert K, Dorizas A, Lorenc P, Sadick NS. Randomized, Controlled, Multicentered, Double-Blind Investigation of Injectable Poly-L-Lactic Acid for Improving Skin Quality. Dermatol Surg. 2019 May;45(5):718-724. doi: 10.1097/DSS.0000000000001772., PMID: 30741790.
8. Fabi S, Hamilton T, LaTowsky B, Kazin R, Marcus K, Mayoral F, Joseph J, Hooper D, Shridharani S, Hicks J, Brasater D, Weinberg F, Prygova I. Effectiveness and Safety of Sculptra Poly-L-Lactic Acid Injectable Implant in the Correction of Cheek Wrinkles., J Drugs Dermatol. 2024 Jan 1;23(1):1297-1305. doi: 10.36849/JDD.7729. PMID: 38206151.
9. Junge K, Binnebösel M, von Trotha KT, Rosch R, Klinge U, Neumann UP, Lynen Jansen P. Mesh biocompatibility: effects of cellular inflammation and tissue remodelling. Langenbecks Arch Surg. 2012 Feb;397(2):255-70. doi: 10.1007/s00423-011-0780-0., Epub 2011 Apr 1. PMID: 21455703.
10. Goldberg D, Guana A, Volk A, Daro-Kaftan E. Single-arm study for the characterization of human tissue response to injectable poly-L-lactic acid. Dermatol Surg. 2013 Jun;39(6):915-22. doi: 10.1111/dsu.12164. Epub 2013 Mar 6. PMID: 23464798. 11. Zubair R, Ishii L, Loyal J, Hartman N, Fabi SG. SPLASH: Split-Body Randomized Clinical Trial of Poly- l -Lactic Acid for Adipogenesis and Volumization of the Hip Dell. Dermatol Surg. 2024 Dec 1;50(12):1155-1162. doi: 10.1097/DSS.0000000000004417., Epub 2024 Nov 6. PMID: 39503574.
12. Huth S, Huth L, Marquardt Y, Jansen M, Lin C, Bartneck M, Baron JM. Molecular Insights Into the Effects of PLLA-SCA on Gene Expression and Collagen Synthesis in Human 3D Skin Models Containing Macrophages. J Drugs Dermatol. 2024 Apr 1;23(4):285-288., doi: 10.36849/JDD.7791. PMID: 38564382.

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