To PEGylate or not to PEGylate: Immunological properties of nanomedicine’s most popular component, polyethylene glycol and its alternatives

COVID-19 Vaccines and the Skin: The landscape of cutaneous vaccine reactions worldwide

Background The use of hyaluronic acid soft tissue fillers in aesthetic medicine exploded in recent years for many reasons, including being relatively safe. Incidence of delayed inflammatory reactions (DIRs) to hyaluronic acid soft tissue fillers range between 0.3% and 4.25%. These reactions are mediated by T-lymphocytes and can be triggered by flu-like illnesses, including SARS-CoV-2 infection. Vaccination may also induce hypersensitivity. Aim In this case report, we present two cases of delayed reaction after hyaluronic acid soft tissue filler treatment of the tear trough area and following mRNA vaccination against SARS-Cov-2, also known as COVID-19, months later. Patients A 39-year old female who previously had her tear trough area treated with hyaluronic acid soft tissue filler developed swelling days after getting the mRNA Pfizer-BioNTech COVID-19 vaccine. Another patient, a 61-year-olf female, developed intermittent facial swelling in areas previously treated with hyaluronic acid soft tissue fillers days after receiving her first dose of the mRNA Pfizer-BioNTech COVID-19 vaccine. Results As demonstrated in our case report, vaccination against COVID-19 may induce DIRs in patients who previously had hyaluronic soft tissue fillers. Conclusion Delayed inflammatory reactions to hyaluronic acid soft tissue fillers are uncommon and usually self-limited, with frequent spontaneous resolution. However, considering the ongoing pandemic and the worldwide demand for vaccines against COVID-19, the aesthetic providers should be conscious of the risks posed by the interaction of such vaccines in patients who previously had or seeking hyaluronic acid soft tissue filler injections.

Hyaluronic acid soft tissue filler delayed inflammatory reaction following COVID-19 vaccination - A case report.

Hypersensitivity reaction to hyaluronic acid dermal filler after the Pfizer vaccination against SARS-CoV-2.

Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments

The incidence of hypersensitivity reactions to hyaluronic acid dermal fillers is between 0.3 and 4.25%, mediated by T-lymphocytes. Flu-like illness can trigger immunogenic reactions at the site of filler placement. Cases of SARS-CoV-2 are significant and pose a possible risk of inducing hypersensitivity. This case report is of a delayed-type hypersensitivity after hyaluronic acid dermal filler treatment of the nose and subsequent infection with SARS-CoV-2. Risk factors for the development of such symptoms were identified as the presence of hyaluronic acid combined with flu-like illness and repeated treatment of one area. The case resolved without intervention. Clinicians should be mindful of the risk posed by the interaction of hyaluronic acid dermal filler with SARS-CoV-2 in light of the pandemic.

M J Rowland-Warmann

Papers

Hypersensitivity reaction to Hyaluronic Acid Dermal filler following novel Coronavirus infection - a case report.