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Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm
Ofir Artzi1,2, Joel L Cohen3, Jeffrey S Dover4,5,6
1Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Clinical, Cosmetic and Investigational Dermatology
|June 18, 2020
Summary
Dual antibiotic therapy is the preferred first-line treatment for delayed inflammatory reactions (DIRs) from hyaluronic acid (HA) fillers. A consensus-based algorithm was developed to guide the management of these common HA filler complications.
Area of Science:
- Dermatology
- Aesthetic Medicine
- Plastic Surgery
Background:
- Delayed inflammatory reactions (DIRs) following hyaluronic acid (HA) filler injections present diverse management challenges.
- Varied clinical approaches necessitate standardized therapeutic guidelines for HA filler complications.
Purpose of the Study:
- To review current management strategies for DIRs associated with HA fillers.
- To establish evidence-based therapeutic guidelines and a treatment algorithm for DIRs.
Main Methods:
- Comprehensive literature review utilizing PubMed with relevant keywords.
- Global expert survey distributed to 18 experienced physicians across 10 countries on DIR management.
- Analysis and consensus-building discussion among surveyed panelists.
Main Results:
- Consensus favored dual antibiotic therapy (fluoroquinolone plus tetracycline/macrolide for 3-6 weeks) as first-line treatment for DIRs.
- Intralesional or systemic steroids were generally avoided unless reactions were severe or disfiguring.
- Intralesional hyaluronidase was recommended by most panelists, with some advocating for a watchful waiting period or prior antibiotic trial.
Conclusions:
- A consensus was achieved on a stepwise treatment algorithm for managing DIRs.
- The proposed algorithm provides a clear and practical approach for clinicians treating HA filler complications.
