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Case report Background: Delayed hypersensitivity reactions to hyaluronic acid fillers are usually self-limiting and uncommon, and spontaneous resolution is frequent. These are presumably T-lymphocyte- mediated reactions that can be caused by flu-like infections and vaccinations. A delayed hypersensitivity reaction after hyaluronic acid filler following the mRNA vaccine against coronavirus has already been described in the literature. We wish to present a case that followed the ChAdOx1-s recombinant COVID-19 vaccine produced by Oxford/ AstraZeneca. Case report: Female patient, 61 years old, submitted to filling of the nasojugal sulcus and nasolabial fold with 1 ml of cross-linked hyaluronic acid -15 mg/ml and after 5 days filling in the lips with 1 ml of cross-linked hyaluronic acid -12 mg/ml, dermatological office, under aseptic technique and using cannulas. It evolved with ecchymosis on the lips and nasolabial folds, with spontaneous resolution after about a week. Sixteen weeks after the procedure, she received the first dose of the ChAdOx1-s recombinant COVID-19 vaccine, and 11 weeks later, the second dose. After 30 days of the 2nd vaccine dose, asymptomatic nodules appeared distributed in the upper and lower portions of nasolabial folds, in melomentonian grooves, in the supralabial region, in the upper and lower lip in the right and left lateral portions and in the infralabial region in the left lateral portion, coinciding with the topographies of the populated areas. Ultrasonographic evaluation with Doppler confirmed these findings. At the time, she denied fever or previous infectious signs or symptoms. Previously, the patient had already been submitted to the filling of the nasojugal and nasolabial folds with a hyaluronic acid-based filler (1 ml), 29 months before the current procedure, without intercurrences. After the appearance of the nodules, she underwent treatment with prednisone 40mg for 15 days, with total weaning after another 15 days, in addition to the use of levoceritizine 5 mg daily for 20 days, with partial reduction in the size of the nodules. Due to aesthetic complaints on the part of the patient, an intralesional injection of hyaluronidase was scheduled, but it was not performed at the request of the patient herself, who opted for expectant management and clinical treatment. In October 2021, the patient reported that the nodules had involuted and in December 2021 she remained asymptomatic, referring to resorption of the entire filler.
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Background: Hyaluronic acid fillers (HAF) are a versatile tool in esthetic medicine. They also have a potential for medical indications including facial rehabilitation. Materials and methods: We performed a literature search on PUBMED and Google Scholar until December 2022. Clinical trials, clinical studies, review articles, systematic reviews, meta-analyses, case series, and case reports were considered for review. Keywords "facial rehabilitation”, "acne scars”, "traumatic scars”, "oral restoration”, "facial lipoatrophy”, "facial asymmetry”, "periocular correction”, "nasal obstruction”, "ear lobe restoration”, "morphea”, AND "hyaluronic acid filler” were used to select articles. Results: We prepared a narrative review on the use of HAF for correction of facial asymmetry and asymmetric lips, improvement of different types of scars, improvement of the jaw line, improvement of ear lobes, periocular and oral restoration, and the treatment of nasal obstruction and morphea en coub de sabre. The amount of HA used in these indications is often less than 1 mL. The bolus technique, fanning, and dual-plane injections can be utilized for treatment. Duration of clinical effects depends upon the anatomical region and is usually maintained between 2 months and 2 years. Adverse events are often mild and temporary. Vascular occlusion is a severe adverse event, but it has not been reported yet for these medical indications. Repeated injections are recommended to obtain a longer-lasting improvement. In cases of morphea, only stable and non-inflammatory plaques should be treated. The advantage of HAF compared to permanent and semipermanent fillers is the availability of hyaluronidase for rapid removal of filler material and to revise overcorrection. Conclusions: HAF play an auxiliary role in facial rehabilitation. Knowledge of filler qualities, anatomy, and underlying diagnoses is important for their safe application. More prospective controlled trials are necessary to improve evidence.
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BACKGROUND: With ongoing COVID-19 vaccination schedules and the popularity of cosmetic fillers, it is important to examine and record associated adverse reactions to a more general audience of health care professionals. Case reports exist in subspecialty journals outlining reactions after SARS-CoV-2 infection and vaccination. This is one of the first cases published in Canada, and it highlights priorities and challenges faced by physicians in assessing and managing patients presenting with adverse reactions post vaccination. CASE PRESENTATION: We present a case of a 43 -year-old women with delayed type 4 hypersensitivity reaction to hyaluronic acid cosmetic filler triggered by COVID-19 mRNA vaccination. We outline the clinical presentation, diagnosis, complications, and treatment of a late inflammatory reaction to hyaluronic acid filler and highlight the treatment priorities for clinicians faced with similar presentations. CONCLUSION: The differential diagnosis of delayed onset nodules formation post filler injection is broad and includes redistribution of fillers, inflammatory reaction to biofilm, and delayed hypersensitivity reaction. As result, in order to make the right diagnosis, administer the appropriate treatment and achieve great cosmetic results, we highly recommend seeking expert opinion from dermatologist, plastic surgeon and allergist immunologist in a timely manner.
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Introduction: Dermal hyaluronic fillers are considered one of the most common minimally invasive procedures in aesthetic surgery. In the last three years, the human population has been significantly affected by the viral disease COVID-19, from which 559 million people have fallen ill and 6.36 million have died worldwide. A new, rare but significant side effect of the COVID-19 disease or a consequence of vaccination against COVID is a delayed inflammatory reaction in the area where dermal fillers were applied. Material(s) and Method(s): We present the case of two patients who developed a delayed inflammatory reaction in the area of the applied filler two and four months after the application of hyaluronic fillers for lip augmentation, and after recovering from COVID and receiving the vaccine against COVID. In both patients, the reaction was manifested by localized edema. Localized infection and the possibility of an allergic reaction to the preparation are excluded. Result(s): After the oral therapy was applied (antihistamines and pulse therapy with corticosteroids) within 24 hours, there was an improvement in the findings and a local regression of the inflammatory reaction. Conclusion(s): A literature review revealed several described cases of delayed inflammatory reaction after a COVID-19 infection or vaccination against COVID, and this side effect is still not often seen in clinical practice. The reaction between the hyaluronic acid filler and the SarsCoV-2 virus is believed to be immune-mediated. Since patients often initially contact the doctor who applied the filler, it is necessary to take into account information about past infection or vaccination in the anamnestic before administering the filler, and to take the delayed inflammatory reaction into account in the differential diagnosis. It is important to recognize this complication in time, to prevent more severe complications in time.
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BACKGROUND: Any implant or external material used in the body tissues can potentially be followed by autoimmune or inflammatory reactions. With the global vaccination program against COVID-19, the reports of tissue filler reactions would be increasingly demonstrated. AIM: To summarize the data regarding COVID vaccination and filler reactions. METHOD: We reviewed the existing data in this regard through searching on PubMed, Google Scholar and Scopus. All of the relevant papers published until March 2022, which we could access to their fulltexts were included. RESULTS: Here, we summarized the data regarding COVID-19 vaccination and filler reactions and discussed its etiopathogenesis, management, and importance. CONCLUSION: Although the end of pandemic was announced, the necessity of continuing COVI-D19 vaccination in future mandates gathering data regarding safety of vaccines.
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BACKGROUND: Poly-D, L-lactic acid is (PDLLA) a new cosmetic filler. We reported the first case of PDLLA-related devastating complication of multiple branch retinal artery occlusion (BRAO). CASE PRESENTATION: A 23-year-old female had sudden blindness after injection of PDLLA at the glabella. After emergency intraocular pressure-lowering medicine, ocular massage, steroid pulse therapy, heparin and alprostadil infusion, and subsequent treatments including acupuncture and 40 sessions of hyperbaric oxygen therapy, her best-corrected visual acuity improved from hand motion at 30 cm to 0.3 within 2 months. CONCLUSION: Although safety of PDLLA was evaluated in animal studies and in 16,000 human cases, it could still cause rare but devastating retinal artery occlusion as in the present case. Proper and immediate therapies could still improve patient's vision and scotoma. Surgeons should keep in mind the possibility of iatrogenic filler-related retinal artery occlusion.
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Face , Retinal Artery Occlusion , Humans , Animals , Female , Young Adult , Adult , Retinal Artery Occlusion/chemically induced , Retinal Artery Occlusion/diagnosis , Eye , Injections , Lactic AcidABSTRACT
BACKGROUND: The aim of our study was to identify and evaluate the complications related to hyaluronic acid during the COVID-19 pandemic. METHOD: Twelve dermatologists participated in this study. A cohort and a non-cohort follow-up were ensured. RESULTS: (1) Cohort follow-up: 1041 patients. 8% had a COVID-19 infection, 27% had received COVID-19 vaccination. 2% had immediate side effects (edema, erythema, bruising). 0.5% had delayed side effects (two inflammatory nodules, one nodule without inflammation, one edema). None of these side effects occurred in the context of infection or COVID-19 vaccinations. (2) Non-cohort follow-up: 7900 syringes used. Two early side effects (inflammatory edema) were reported, of which one occurred 15 days after vaccination. Two cases of delayed side effects such as inflammation on the injected area and inflammatory nodules occurred of which one was in the context of vaccination and one during COVID-19 infection. We estimate the frequency of complications possibly attributable to the disease or to the COVID vaccination to be 0.06% in our population. DISCUSSION: Complications of HA injections in the context of COVID-19 disease or vaccination appear to be very rare but the frequency could be underestimated because of the low rate of vaccination/infection in our population. Our study shows a very good tolerance of hyaluronic acid injections during the COVID-19 pandemic.
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Background Generally, the diagnosis of OCD can be considered after a history of exposure to the suspected material and a thorough physical examination. Meanwhile, vital information about it is often overlooked during the initial consultation. Objective Evaluating the epidemiological profile of OCD cases in health workers due to the COVID-19 pandemic and evaluating complaints, manifestations and causative materials of OCD cases in health workers at the isolation ward of Dr. Soetomo Surabaya Hospital during the Covid-19 pandemic. Methods Purposive sampling was used to design research samples from accessible populations that matched the inclusion requirements while those who met exclusion criteria were included as research samples. Results Majority OCD patients are women and the most common age range is between 22-35 years old. The occupation most affected by OCD while working at isolation ward during the pandemic is nurses. The most common complaint is itching followed by redness of the skin which appears most frequently on the hands. The most prominent clinical manifestations are desquamation followed by erythema-like skin lesions. Medical gloves are the sort of personal protection equipment that causes OCD the most, followed by hand hygiene activities. High risk factors for OCD include a family history of atopic illnesses, history of asthma and an early history of atopic dermatitis. Conclusion The use of PPE can cause several effects on the skin such as physical trauma to the skin, acne, contact dermatitis, urticaria, and aggravate previous skin diseases. The most common skin disorders are erythema, papules, scales, fissures, erosions, ulcers, vesicles and wheals. Complaints of contact dermatitis can be reduced and prevented by taking preventive measures in the form of using moisturizers on areas that are often exposed. Copyright © 2023 Pakistan Association of Dermatologists. All rights reserved.
Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Foreign-Body Reaction/etiology , Acrylic Resins/adverse effectsABSTRACT
Background: Late hypersensitivity reactions (HSRs) to the BNT162b2-vaccine have raised concerns regarding its safety, particularly as further immunizations are required. The yield of skin testing with the BNT162b2v is unclear, as well as the risk factors and outcomes of re-immunization after late HSRs. Objective: We studied a series of patients with late HSRs to BNT162b2v. Methods: Patients referred to the Sheba medical center from December 2020 to May 2021 with late HSRs to the first dose of BNT162b2 were included. HSRs were defined as late if they appeared or lasted >24 h after inoculation. We compared late HSRs to immediate HSRs that appeared within minutes−2 h after vaccination. Intradermal testing with PEG-containing medication and BNT162b2v was performed. Results: A total of 17 patients that presented with late HSRs (study group) were compared to 34 patients with immediate HSRs (control group). Delayed sensitivity to intradermal testing of the BNT162b2v was observed in 9/17 (53%) of the study group compared to 4/34 (12%) in the control group (p = 0.01). Former exposure to a dermal filler with hyaluronic acid was documented among 7/17 (41%) vs. 2/34 (6%) in the study and control groups, respectively, (p = 0.0038). All patients who presented with late HSRs were advised to receive subsequent doses of the BNT162b2v vaccine with or without concomitant medication, and all were re-immunized successfully. Conclusions: Late HSRs to BNT162b2v were linked with positive responses to intradermal testing with the vaccine and prior exposure to derma fillers with hyaluronic acid. This may elude to an immune mechanism triggered by former exposures. Although further studies are needed, late HSRs to the BNT162b2-vaccine did not prevent patients from receiving subsequent doses of the vaccines.
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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.
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Hyaluronic acid dermal fillers are a very popular choice for patients wanting to undergo non-invasive facial rejuvenation. Its prevalence is predicted to continue to rise. We report a case of delayed angioedema and associated urticaria to hyaluronic acid dermal fillers post COVID-19 infection. To our knowledge, this is an unusual case of hypersensitivity reaction of eight-month latency. Although the aetiology warrants further research, the author suggests utilisation of a four-week time window between dermal filler injections and COVID-19 vaccination.
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Advancements in polymer science and engineering have helped the scientific community to shift its attention towards the use of environmentally benign materials for reducing the environmental impact of conventional synthetic plastics. Biopolymers are environmentally benign, chemically versatile, sustainable, biocompatible, biodegradable, inherently functional, and ecofriendly materials that exhibit tremendous potential for a wide range of applications including food, electronics, agriculture, textile, biomedical, and cosmetics. This review also inspires the researchers toward more consumption of biopolymer-based composite materials as an alternative to synthetic composite materials. Herein, an overview of the latest knowledge of different natural- and synthetic-based biodegradable polymers and their fiber-reinforced composites is presented. The review discusses different degradation mechanisms of biopolymer-based composites as well as their sustainability aspects. This review also elucidates current challenges, future opportunities, and emerging applications of biopolymeric sustainable composites in numerous engineering fields. Finally, this review proposes biopolymeric sustainable materials as a propitious solution to the contemporary environmental crisis. © 2022 Elsevier Ltd.
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We report two cases of inflammatory reaction to postvaccination to Pfizer COVID-19 vaccine from Saudi Arabia: A case of delayed inflammatory reactions (DIRs) to hyaluronic acid (HA) dermal filler in the upper lip following the first dose of messenger ribonucleic acid Pfizer-BioNTech COVID-19 vaccine;the second case of DIR to HA filler underneath of eye following the second dose of Pfizer COVID-19 vaccine. The mechanism of this late reaction to HA fillers may be dependent on numerous factors and is not well understood.
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The emergence of vaccines for coronavirus disease 2019 (COVID-19) raises risk of possible adverse events from interaction between the vaccines and facial aesthetic care. A 47-year-old female with no medical comorbidities visited our emergency room due to midface painful swelling after 3 hours following receiving the second dose of the messenger RNA BNT162b2 COVID-19 vaccine. About 14 years ago, she underwent nonsurgical augmentation on the nasojugal groove with a calcium hydroxylapatite dermal filler. We performed incision and drainage under general anesthesia on the next day. During operation, yellowish pus-like materials bulged out. After an operation, we performed a combination therapy with antibiotics and methylprednisolone. Her symptoms improved day by day after surgery, and then a complete recovery was achieved at 3 weeks after the treatment. In conclusion, providers of aesthetic procedures are to be aware of the potential risks of such vaccines for patients who already had or seek to receive dermal filler injections.
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BACKGROUND: Treatments based on hyaluronic acid represent one of the most largely used practice of esthetic medicine. In the literature, it has already been described delayed reaction after vaccine like flu vaccine mediated by T-lymphocytes. AIM: We report three cases of dermal filler reactions following mRNA vaccination against SARS-CoV-2; all the patients had received the filler months or even years before the vaccine. PATIENTS: Patient one: A 60-year-old female patient that was treated one year ago in the lip developed swelling days after getting mRNA Pfizer Biotech vaccine. She received her booster of Pfizer vaccination one week before. Patient two: A 45-year-old female patient treated in the lip two years before developed angioedema days after getting her booster of Pfizer Biotech vaccine. In this case, it was necessary to prescribe cortisone per os. Patient three: A 40-year-old female patient treated for the nasolabial fold five months before developed erythema and edema after receiving the booster of Moderna Vaccine. RESULTS: As demonstrated in our three case reports, even the booster of vaccine can cause delayed inflammatory reactions in patients that have previously received fillers. CONCLUSION: Delayed inflammatory reactions in patients that have received filler in the past are uncommon and usually self-limited. Those are the first example reported in the literature of reaction after the booster dose without any previous symptoms.