[Angioedema associated with hyaluronic acid injection]

Angioedema is a form of localized swelling involving the deeper layers of the skin and mucous membranes, caused by fluid extravasation and lasting for several days. While aging of the skin is a natural process, various compounds such as hyaluronic acid, active amino acids, and peptides are used for their anti-aging properties. However, in some individuals, these substances can overstimulate the immune system, triggering hypersensitivity reactions.

A 38-year-old woman with a medical history of controlled hypertension and allergy to quinolones. She underwent hyaluronic acid injections in the lips and glabellar region four months before presenting symptoms. Over the last three months, she experienced intermittent, firm, painful, erythematous lip swelling with paresthesia, which did not respond to antihistamines or steroids. Immunological tests showed positive antinuclear antibodies (ANA) with a granular pattern, but rheumatology ruled out autoimmune disease. An ultrasound revealed encapsulation of the injected material.

Hyaluronic acid, widely used in aesthetic medicine, can cause immune mediated adverse effects, including angioedema. Though rare with an incidence of 0.42% such reactions can be serious. Treatment options include dissolving the material using hyaluronidase, applying radiofrequency, administering intralesional corticosteroids, or performing surgery. Type IV hypersensitivity angioedema is rare and may be caused by bacterial proteins or impurities in hyaluronic acid. It does not respond to antihistamines and requires treatment with hyaluronidase, intralesional steroids, radiofrequency, or surgery. This raises questions about the mechanisms underlying the immunogenicity of hyaluronic acid that warrant further investigation.