Attitudes toward dermocosmetic and aesthetic procedures in patients with systemic sclerosis: a cross-sectional survey

Systemic sclerosis (SSc) frequently causes visible changes in physical appearance that may adversely affect body image and quality of life. Although dermocosmetic and aesthetic procedures are increasingly used to improve appearance and function in selected patients with SSc, little is known about patients' knowledge, attitudes, and expectations regarding these interventions. This study aimed to evaluate patients' attitudes toward dermocosmetic and aesthetic procedures using a purpose-designed questionnaire. In this cross-sectional study, 70 patients fulfilling the 2013 ACR/EULAR classification criteria for SSc completed a purpose-designed questionnaire. Demographic data were obtained from the questionnaire, while clinical characteristics were verified using medical records. The questionnaire evaluated knowledge, attitudes, previous experiences, future intentions, appearance-related concerns, perceived effects on self-confidence, willingness to consult a rheumatologist before aesthetic procedures, and preferred anatomical sites for potential interventions. The mean age was 54.6 ± 13.3 years, 90.0% were female, and 55.7% had diffuse cutaneous SSc. Disease-related changes in physical appearance were reported by 70.0% of participants, and 41.4% expressed discomfort with these changes. Nearly half (47.1%) reported no knowledge of any dermocosmetic procedure, and 85.7% had not previously undergone a dermocosmetic/medical aesthetic procedure. Nevertheless, 61.4% expressed positive attitudes toward dermocosmetic procedures, and 64.3% believed that these procedures could improve self-confidence. Nearly all participants (97.2%) stated that they would consult their rheumatologist before undergoing a dermocosmetic or aesthetic procedure. After false discovery rate (FDR) correction, diffuse cutaneous SSc remained associated with greater appearance-related discomfort than limited disease (53.8% vs. 25.8%; FDR-adjusted p = 0.032). Participants with at least a high school education more frequently expressed positive attitudes (83.9% vs. 43.6%; FDR-adjusted p = 0.014) and reported plans for future dermocosmetic/medical aesthetic (45.2% vs. 20.5%; FDR-adjusted p = 0.038) and surgical aesthetic procedures (22.6% vs. 2.6%; FDR-adjusted p = 0.032). In multivariable logistic regression adjusted for age and SSc subtype, higher education remained independently associated with a positive attitude (adjusted OR 6.43, 95% CI 1.73-23.91, p = 0.006). Appearance-related concerns are common among patients with SSc and represent an important yet often overlooked aspect of patient care. Despite limited knowledge, patients generally expressed favorable attitudes toward dermocosmetic and aesthetic procedures and strongly preferred consulting their rheumatologists before considering such interventions. These findings support the integration of appearance-related counselling into routine, patient-centered rheumatology care.