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Journal ArticleDOI

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

01 May 2021-Journal of Cosmetic Dermatology (John Wiley & Sons, Ltd)-Vol. 20, Iss: 5, pp 1557-1562
TL;DR: In this article, a delayed-type hypersensitivity after hyaluronic acid dermal filler treatment of the nose and subsequent infection with SARS-CoV-2 was reported.
Abstract: 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.
Citations
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Journal ArticleDOI
TL;DR: The use of polyethylene glycol (PEG) has a long history of use in medicine and many conventional formulations utilize PEG as either an active ingredient or an excipient as mentioned in this paper .

80 citations

Journal ArticleDOI
TL;DR: The authors reviewed the dermatologic manifestations of COVID-19 vaccines as reported in clinical trial data and summarized additional observational reports of skin reactions to COVID19 vaccines, concluding that early-onset local injection reactions were the most common cutaneous side effects observed in clinical trials, while delayed injection reactions reported outside of clinical trials.

75 citations

Journal ArticleDOI
TL;DR: In this article, the authors 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.
Abstract: 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.

45 citations

Journal ArticleDOI
TL;DR: In this article, the development of hyaluronic acid soft tissue filler delayed inflammatory reactions following COVID-19 vaccination was reported and the case of a 38-year-old female patient with a confirmed hypersensitivity reaction after having the BNT162b2 vaccine (Pfizer, USA).

18 citations

Journal ArticleDOI
TL;DR: In this paper, a 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related, which is a methodical strategy aimed at further minimising the risk of dermal filler complications.
Abstract: 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.

15 citations

References
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Journal ArticleDOI
TL;DR: This review focuses on the role of hyaluronan as an immune regulator in human diseases through regulating inflammatory cell recruitment, release of inflammatory cytokines, and cell migration.
Abstract: Accumulation and turnover of extracellular matrix components are the hallmarks of tissue injury. Fragmented hyaluronan stimulates the expression of inflammatory genes by a variety of immune cells at the injury site. Hyaluronan binds to a number of cell surface proteins on various cell types. Hyaluronan fragments signal through both Toll-like receptor (TLR) 4 and TLR2 as well as CD44 to stimulate inflammatory genes in inflammatory cells. Hyaluronan is also present on the cell surface of epithelial cells and provides protection against tissue damage from the environment by interacting with TLR2 and TLR4. Hyaluronan and hyaluronan-binding proteins regulate inflammation, tissue injury, and repair through regulating inflammatory cell recruitment, release of inflammatory cytokines, and cell migration. This review focuses on the role of hyaluronan as an immune regulator in human diseases.

853 citations

Journal ArticleDOI
TL;DR: It is demonstrated that LMW HA activates the innate immune response via TLR-2 in a MyD88-, IL-1R-associated kinase-, TNFR-associated factor-6-, protein kinase Cζ-, and NF-κB-dependent pathway and can act as an adjuvant promoting Ag-specific T cell responses in vivo in wild-type mice.
Abstract: Upon tissue injury, high m.w. hyaluronan (HA), a ubiquitously distributed extracellular matrix component, is broken down into lower m.w. (LMW) fragments, which in turn activate an innate immune response. In doing so, LMW HA acts as an endogenous danger signal alerting the immune system of a breach in tissue integrity. In this report, we demonstrate that LMW HA activates the innate immune response via TLR-2 in a MyD88-, IL-1R-associated kinase-, TNFR-associated factor-6-, protein kinase Cζ-, and NF-κB-dependent pathway. Furthermore, we show that intact high m.w. HA can inhibit TLR-2 signaling. Finally, we demonstrate that LMW HA can act as an adjuvant promoting Ag-specific T cell responses in vivo in wild-type but not TLR-2 null mice.

659 citations

Journal ArticleDOI
20 Feb 2018-Immunity
TL;DR: How human T cells develop and provide essential immune protection at different life stages is discussed and tissue localization and subset delineation are highlighted as key determinants of the T cell functional role in immune responses.

657 citations

Journal ArticleDOI
TL;DR: Understanding immune evasion strategies of SARS-CoV2 and the resulting delayed massive immune response will result in the identification of biomarkers that predict outcomes as well as phenotype and disease stage specific treatments that will likely include both antiviral and immune modulating agents.

482 citations

Journal ArticleDOI
TL;DR: For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.
Abstract: Background The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase.

348 citations

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