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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 


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