This is a question I am regularly asked by patients being followed for an autoimmune disease: 'Am I allowed to have hyaluronic acid injections?' The answer calls for nuance — neither a blanket ban nor complacency. Here is what current data says, and how I proceed in practice.
What the literature says
Hyaluronic acid (HA) is a molecule naturally present in our bodies. Recent scientific reviews of its use in patients with autoimmune inflammatory diseases (lupus, rheumatoid arthritis, scleroderma…) reach a reassuring conclusion: no clinical study formally contraindicates HA-based fillers in these situations. A survey of nearly 500 patients with inflammatory rheumatic diseases showed that injections, mostly performed during remission, caused only mild, transient adverse effects, with high satisfaction.
There is, however, an important caveat: delayed inflammatory reactions (nodules, swelling appearing weeks after the injection) are slightly more frequent in people whose immune system is imbalanced. They usually stem from a delayed-type hypersensitivity and generally remain treatable (hyaluronidase, corticosteroids depending on the case).
The principle: stable disease, heightened caution
The rule I apply is simple. During an active flare of the disease, we postpone: it is not the moment to add a stimulus to the immune system. When the disease is stable, controlled and in remission, injections can usually be considered, with heightened precautions:
- a thorough medical history and, if needed, a conversation with your GP or specialist (rheumatologist, internist);
- a preference for reversible hyaluronic acid (dissolvable with hyaluronidase if a problem arises), rather than non-resorbable products;
- clear information about the risk of a delayed reaction and its management;
- measured quantities and a meticulous technique.
My protocol in case of doubt: the forearm test
When the situation is uncertain — a history of reaction, a disease that is harder to balance, a patient's legitimate concern — I offer an extra safety step. Rather than injecting the face straight away, I perform a test: a small intradermal injection of the intended product, on the inner forearm. The area is then observed for about a month, looking for any local reaction (persistent redness, nodule, swelling).
If, after this period, tolerance is perfect, we can then treat the face with the same product — the very one that was tested. This approach does not remove all risk, but it provides concrete reassurance and allows treatment to proceed with confidence. It is a precaution I consider useful in specific cases, on a case-by-case basis.
In summary
An autoimmune disease is not, on its own, a contraindication to hyaluronic acid injections. It is all a matter of timing (controlled disease), product choice (reversible) and individualised caution. In case of doubt, the prior forearm test offers additional safety. The decision is always made in consultation, after a precise assessment of your situation. You can learn more about dermal filler injections and hyaluronic acid.
In aesthetic medicine as elsewhere, safety comes before aesthetics: a test and a month's wait are better than an avoidable complication.
Sources: 'Hyaluronic acid-based fillers in patients with autoimmune inflammatory diseases', Journal of Cosmetic Dermatology, 2023 — DOI 10.1111/jocd.15751; 'Safety of esthetic procedures in rheumatic patients', 2024 — PMC10796409; 'Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation', 2024 — PMC11265052.