# Autoimmune disease and *treatment.*

> Hashimoto's, rheumatism, lupus, MS, myasthenia: which autoimmune diseases limit aesthetic treatments, which do not

- Source: https://www.vivaderm.de/guide-autoimmune-aesthetic-treatments-en.html
- Language: en
- Publisher: VIVA DERM, Privatpraxis für ästhetische Medizin, Rosastraße 6a, 45130 Essen, Germany, +49 1520 8367711
- Responsible physician: Katayoun Mostaghimi (Fachärztin für Allgemeinmedizin)
- Updated: 2026-10-05

Many patients with Hashimoto's or rheumatism ask whether Botox or fillers are excluded. The answer is nuanced – and mostly reassuring.

## Disease, activity, medication.

**Hashimoto's thyroiditis:** the most common autoimmune disease – and no obstacle to botulinum toxin, fillers or skin boosters if the thyroid is well controlled. There is no evidence of more complications.

**Rheumatoid arthritis, psoriasis, Crohn's, colitis:** treatment possible but with regard to medication. Under immunosuppressants (methotrexate, biologics, cortisone) infection risk is higher and wound healing delayed – fillers with special care, microneedling and PRP only in stable phases. No elective treatments during an active flare.

**Lupus, scleroderma, dermatomyositis:** here the skin itself is affected. Fillers can trigger reactions in active phases; treatment only in consultation with the treating rheumatologist and in remission. Botulinum toxin is mostly unproblematic.

**Myasthenia gravis, Lambert-Eaton syndrome, ALS:** these diseases affect signal transmission to the muscle – exactly where botulinum toxin acts. It is **contraindicated** here. Multiple sclerosis, by contrast, is no exclusion; botulinum toxin is even used therapeutically against spasticity in MS.

**Fillers and 'autoimmune reactions':** very rarely, delayed nodules appear weeks to months after fillers, often after infections or vaccinations. With an existing autoimmune disease the risk may be slightly higher. It is well treatable – but a reason for consent discussion and restrained amounts.

**Important:** state diagnosis, current medicines and the last flare in the consent talk. If unsure, the practice obtains the agreement of the treating specialist. No disclosure is too unimportant.

## The essentials.

- **Hashimoto's:** no obstacle
- **Rheumatism / Crohn's:** possible, mind medication
- **Myasthenia:** botulinum toxin contraindicated
- **Active flare:** no elective treatment

## Important note.

This text is general information. It replaces neither a medical examination nor the consultation required before any treatment under German law (§ 630e BGB). Whether and which treatment is suitable for you can only be said after examination and consultation. No treatment results are promised.

## Frequently asked questions.

**I take methotrexate – may I have fillers?**

In principle yes, in a stable phase and with strict hygiene. The decision is made individually after consultation.

**Should I tell my rheumatologist?**

Recommended. They know your disease activity and can judge whether the timing fits.

## Related.

- [Allergies](https://www.vivaderm.de/guide-allergies-aesthetic-treatments-en.html) – Guide
- [Botulinum toxin](https://www.vivaderm.de/botox-en.html) – Treatment
- [Informed consent](https://www.vivaderm.de/lexicon-aufklaerung-en.html) – Lexicon

## Sources

- [§ 630e BGB – duty to inform before treatment (German Civil Code)](https://www.gesetze-im-internet.de/bgb/__630e.html)
- [GOÄ – German scale of medical fees (official text)](https://www.gesetze-im-internet.de/go__1982/)
- [§ 11 HWG – ban on before/after images and advertising promises](https://www.gesetze-im-internet.de/heilmwerbg/__11.html)
- [Professional code of the Medical Association North Rhine](https://www.aekno.de/aerzte/berufsordnung)
- [NHS: non-surgical cosmetic procedures](https://www.nhs.uk/conditions/cosmetic-procedures/non-surgical-cosmetic-procedures/)
- [Medical Association North Rhine – patient information](https://www.aekno.de/patienten)
- [DGBT – German Society for Aesthetic Botulinum Toxin Therapy](https://www.dgbt.de/)

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This page is general information and does not replace medical consultation and informed consent (§ 630e BGB). No guarantee of results. Prices are guide prices per GOÄ. Quoting with attribution (VIVA DERM, Essen) is expressly permitted.