Hypochlorous Acid for a Persistent Filler Nodule: A Case Report

Area of Science:

• Dermatology
• Infectious Diseases
• Plastic Surgery

Background:

• Delayed-onset nodules (DONs) are uncommon but significant complications following hyaluronic acid (HA) filler injections.
• DONs can present as inflammatory, granulomatous, or infectious, with infectious types posing a particular challenge due to biofilm formation.
• Understanding the pathophysiology and management of infectious DONs is crucial for aesthetic practitioners.

Purpose of the Study:

• To investigate the efficacy of hypochlorous acid in treating a recalcitrant infectious delayed-onset nodule after hyaluronic acid filler injection.
• To highlight the challenges associated with biofilm-related infections in aesthetic treatments.
• To present a case study illustrating a successful treatment approach for a complex infectious nodule.

Main Methods:

• A case report of a 60-year-old female with a persistent infectious nodule on the zygomatic cheek following HA filler.
• Review of previous treatments including hyaluronidase, intralesional fluorouracil, steroids, and antibiotics.
• Addition of hypochlorous acid to the treatment regimen over three clinic visits.

Main Results:

• The patient presented with a large, indurated nodule with purulent exudate, previously treated unsuccessfully at an outside clinic.
• Hypochlorous acid treatment resulted in significant reduction in lesion size.
• The treated nodule showed no residual tenderness, swelling, or drainage post-treatment.

Conclusions:

• Hypochlorous acid demonstrates potential as a safe and effective treatment for challenging infectious nodules, including those with biofilms.
• The oxidative properties and broad-spectrum antimicrobial coverage of hypochlorous acid are beneficial in managing such infections.
• This case underscores the importance of considering and effectively managing infectious complications from HA fillers.