MJ Rowland-Warmann BDS, MSc Aes Med, MClinDent Orthod, MJDF
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.
Delayed-type hypersensitivity reactions do not improve with the use of antihistamines.5,6 Due to their often transient presentation, intervention may not be necessary. If persistent, steroids may be required to alleviate symptoms. Dose recommendations ranging between 30 and 60 mg daily and tapering down over 5 days depending on symptom severity have been advocated.2- 7 If the diagnosis is unclear and an infection is suspected, steroids should not be prescribed.6
Cases of dermal filler swelling resulting from SARS-CoV-2 vaccination with the Moderna-type vaccine (Moderna, Cambridge MA) have been successfully treated with Lisinopril, an angiotensin- converting enzyme inhibitor (ACE-1) to decrease cutaneous inflammation within 72 hours. ACE-1 treatment has previously been used in the treatment of hypertrophic scars, keloids, and other inflammatory skin disorders and can assist in downregulating CD44 by inhibiting the pro-inflammatory Angiotensin II.40 Lisinopril is well tolerated and a dose of 10 mg for 3–5 days suggested.40