lupus panniculitis ( lp ) occurs in 3% of the patients with cutaneous lupus erythematosus .
it primarily affects subcutaneous tissues of the face and the proximal areas of the limbs , leading to residual atrophy .
lp may lead to major aesthetic sequelae that severely decrease quality of life ( even during good long - term control of the autoimmune processes ) . given the condition 's low prevalence , treatment strategies in lp
only 1 case of lipofilling has been reported with a follow - up period limited to 12 months . here ,
we report on the strikingly good aesthetic outcomes , the long - term quality - of - life benefits , and the safety of lipofilling in 2 patients with lp - associated subcutaneous atrophy .
patient 1 ( a 13-year - old boy ) was referred for an ill - defined subcutaneous inflammatory nodule on the chin . a histopathological examination revealed a marked lymphocytic infiltrate ( in superficial and deep tissues ) with juxtafollicular involvement , prompting us to diagnose lp .
treatment with hydroxychloroquine for 18 months led to the complete disappearance of inflammatory signs but resulted in a cup - shaped lipoatrophy and facial asymmetry .
patient 2 ( a 32-year - old female ) had been monitored over a 6-year period for systemic lupus erythematosus with positive antinuclear and anti - double - stranded dna antibodies . during treatment with hydroxychloroquine , she presented with subcutaneous inflammatory lesions on the thighs and cheeks .
a diagnosis of lp was confirmed by histopathological examination of a skin biopsy according to the criteria by peter and su .
the initial response to oral prednisone was good , but the patient became steroid dependent .
a series of steroid - sparing agents was then administered ( including thalidomide , cyclophosphamide , and azathioprine ) .
four weekly intravenous infusions of rituximab ( 375 mg / m ) , which were repeated 1 year later , led to complete remission , although atrophic scarring in malar areas persisted . following a request from both patients for correction of the aesthetic sequelae , we chose to use lipofilling .
briefly , 10 ml of fat were collected via a 2-mm incision below the umbilicus .
next , fat cells were injected into the submental ( patient 1 ) or malar ( patient 2 ) areas using coleman needles .
there were no complications , and the positive aesthetic outcome was maintained 3 years after the procedure with no signs of the recurrence of lp ( fig 1 ) .
the dermatology quality of life index decreased from 16 before lipofilling to 0 six months thereafter ( patient 1 ) .
lipofilling is a well - established technique widely used in the rejuvenation of the aging face and in iatrogenic lipoatrophy [ 7 , 8 ] .
this technique was also used successfully in some cases of linear scleroderma en coup de sabre .
most of the common side effects of lipofilling are not severe . nevertheless , it is critical for surgeons to have a firm knowledge of the vascular anatomy because some cases of irreversible blindness have been reported .
the good response of patient 2 to rituximab suggests that the efficacy of rituximab as a salvage therapy for treatment - refractory lp should be assessed in prospective trials . along with a previous report
, the 2 present cases suggest that lipofilling is effective for treating the atrophic scars that result from permanent alterations of the subcutaneous fatty tissue in lp .
moreover , the short- and long - term absence of any signs of lupus relapse or postsurgical complications is encouraging .
the lipofilling procedure appears to be very safe when performed in patients with stable disease and thus paves the way for prospective , larger - scale studies in patients with completely controlled autoimmune disorder .
these long - term , controlled trials will be able to accurately assess the benefit - risk ratio of lipofilling in lp and other immune - related subcutaneous scarring conditions .
 lupus panniculitis is a rare manifestation of cutaneous lupus erythematosus , which may lead to major aesthetic sequelae with a severe impact on patients quality of life . 
 we report 2 cases supporting the short- and long - term efficacy and safety of lipofilling in the treatment of lupus panniculitis - induced atrophy . 
 these observations pave the way for prospective , larger - scale studies in patients with scarring lupus panniculitis , provided that the autoimmune pathogenic process is in complete , stable remission . 
Introduction
Case Presentations
Discussion
Statement of Ethics
Disclosure Statement