Casuistic chain: COVID-19, inflammatory response to hyaluronic acid-based filler and xanthelasma

The pandemic of a new coronavirus infection has posed many challenges and questions for medicine. Dermatologists, in particular, have encountered a wide variety of cutaneous manifestations of this infection. Apart from a fairly broad coverage of various rashes and features of the course of many chronic dermatoses, only sporadic descriptions of inflammatory reactions to cosmetic fillers are available. Objec-tives. An extremely rare complication is described: an inflammatory reaction to the injection of a hyaluronic acid-based filler, which, in turn, led to the occurrence of xanthelasma at the sites of filler localization during the recovery period after COVID-19. Material and methods. A patient presented with yellow lesions in the nasolacrimal sulcus area following the resolution of an inflammatory response to the injection of a hyaluronic acid-based filler during the recovery period after a COVID-19 infection. Results. The diagnosis was confirmed by ultrasound of the face skin and soft tissues, and the optimal therapy regimen was determined. Conclusion. In the global medical practice, only single cases of xanthelasma and xanthelasma-like reactions after the filler injection are report-ed. In a scientific first, the pathogenetic chain including COVID-19, filler inflammatory response, and xanthelasma is described. The patho-genesis of this complication is also of particular interest and needs further study. Although extremely rare, physicians should be aware of this complication and its treatment options.

[BIOLOGICAL TREATMENT OF PSORIASIS IN TIME OF NEW CORONAVIRUS INFECTION COVID-19].

Currently, the ongoing pandemic of the novel coronavirus infection is still a major public health problem worldwide. The questions of immunosuppressive therapy of patients with psoriasis and psoriatic arthritis, the possibility of vaccination against the background of the use of genetically engineered drugs remain open. The article is of an overview nature and includes up-to-date information on the feasibility and safety of the use of genetically engineered biological drugs in patients with psoriasis in a pandemic (COVID-19). According to the international recommendations of the National Psoriasis Foundation COVID-19 Task Force expert group, treatment of psoriasis and/or PsA does not significantly alter the risk of SARS-CoV-2 infection and does not lead to worse prognosis of COVID-19. Therefore, patients not infected with SARS-CoV-2 should continue biological or other systemic therapy for psoriasis and/or PsA. According to a registry from 25 countries, hospitalization with SARS-CoV-2 infection was more common in patients receiving nonbiological systemic therapy than in patients receiving BAs. Thus, genetically engineered biological drugs do not appear to cause an increased risk of coronavirus infection and do not determine a more severe course. With regard to vaccination of patients with psoriasis, many issues require further study. According to international agreements, vaccination is not contraindicated in patients with psoriatic disease. However, there is still insufficient data on how the treatment of psoriatic disease affects vaccination. Avoiding COVID-19 or reducing the severity of infection following SARS-CoV-2 vaccination is thought to far outweigh any risk directly related to vaccination complications.

Covid-19 and delayed inflammatory reactions to hyaluronic acid fillers: What we know about it?

Actuality. In recent years in aesthetic medicine, there has been a steadily increasing popularity of the use of various fillers in order to correct aesthetic imperfections and age-related changes. Traditionally, the most widely used fillers are based on hyaluronic acid due to their high safety profile, biocompatibility, a wide range of indications and the presence of an antidote in the form of hyaluronidase preparations. However, in some cases, a late complication such as a delayed inflammatory response may occur. Various triggering factors can lead to its appearance, including influenza-like illnesses, and also coronavirus infection caused by the SARS-CoV-2 virus. Objective. The article provides a detailed description of the occurrence of a delayed inflammatory reaction in the localization of a filler based on hyaluronic acid against the background of a new coronavirus infection (COVID-19), as well as analyzes clinical cases presented in scientific publications. Material and methods. A 49-year-old female patient complained of recurrent inflammation in the areas of injection of a filler based on hyaluronic acid. For the first time, the onset of an inflammatory reaction occurred against the background of the COVID-19 disease. Results. After additional examination methods (ultrasound of the skin and soft tissues of the face), a diagnosis was made and therapy was prescribed (antibiotics, dexamethasone per os for a long time, enzymatic resorption of the filler by hyaluronidase, external therapy: tacrolimus). Conclusions. Delayed inflammatory responses of hyaluronic acid fillers, despite the rarity of occurrence, are currently the focus of attention. The worldwide interest in this problem is associated with the etiology and pathogenesis of their occurrence, which are complex and multifactorial and are not fully understood. As practical observations show during the ongoing pandemic, the SARS-CoV-2 virus may be a risk factor for the occurrence of delayed inflammation in this category of patients with an aesthetic profile. © 2021, Media Sphera Publishing Group. All rights reserved.

Possible role of anti-IL17 drugs in the management of COVID-19: Our own experience and literature review

Coronavirus infection COVID-19 is an acute respiratory viral disease caused by a novel beta-coronavirus SARS-CoV-2. In 81 % of cases, mortality in COVID-19 patients is associated with the development of acute respiratory distress syndrome (ARDS). Another critical challenge associated with COVID-19 is the development of a cytokine storm, which is an uncontrolled release of proinflammatory mediators due to the excessive activation of immune system. Cytokine storm is another cause of high mortality because of COVID-19, as it leads to multiple organ failure, ARDS and disseminated intravascular coagulation (DIC). Thus, the management of cytokine storm and ARDS in COVID-19 patients is an urgent issue for the medical society. Recent research assessed the potential role of interleukin(IL)-17 in the pathogenesis of cytokine storm and ARDS in COVID-19 patients. Some authors also pointed to using anti-IL17 medications in the management of patients with severe COVID-19. The present article gives a literature review on the possible role of IL-17 in COVID-19 pathogenesis and our personal experience of anti-IL17 prescription for patients with severe course of COVID-19.