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Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm

Artzi O 1 , Cohen JL 2 , Dover JS 3 , Suwanchinda A 4 , Pavicic T 5 , Landau M 6 Show all authors , Goodman GJ 7 , Ghannam S 8 , Al Niaimi F 9 , van Loghem JAJ 10 , Goldie K 11 , Sattler S 12 , Cassuto D 13 , Lim TS 14 , Wanitphakdeedecha R 15 , Verner I 16 , Fischer TC 17 , Bucay V 18 , Sprecher E 1 , Shalmon D 1

Affiliations 

  • 1 Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  • 2 AboutSkin Dermatology and AboutSkin Research, , Greenwood Village and Lone Tree, CO, USA
  • 3 SkinCare Physicians, Chestnut Hill, MA, USA
  • 4 Department of Dermatology, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
  • 5 Private Practice for Dermatology and Aesthetics Dr. Tatjana Pavicic, Munich 80539, Germany
  • 6 Dermatology, Private Practice, Herzliya, Israel
  • 7 Monash University, Clayton, Victoria, Australia
  • 8 Associate Prof. of Dermatology, Alexandria University, Alexandria, Egypt
  • 9 152, Harley street, London, UK
  • 10 UMA Institute, Amsterdam 1017, TX, Netherlands
  • 11 Medical Director European Medical Aesthetics Ltd, London W1G 8QN, UK
  • 12 Rosenpark Klinik, Darmstadt, Germany
  • 13 Private Practice, Milan, Italy
  • 14 Clique Clinic, Kuala Lumpur, Malaysia
  • 15 Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 16 Verner Clinic, Tel Aviv, Israel
  • 17 Skin and Laser Center, Potsdam, Germany
  • 18 Bucay Center for Dermatology and Aesthetics, UTHSC, San Antonio, TX, USA
Clin Cosmet Investig Dermatol, 2020;13:371-378.
PMID: 32547150 DOI: 10.2147/CCID.S247171

Abstract

Background and Objectives: There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose.

Materials and Methods: A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists.

Results: Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement.

Conclusion: A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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