Systematic Review of Post-Viral Delayed Inflammation Associated with Hyaluronic Acid Dermal Fillers

Area of Science:

• Dermatology
• Immunology
• Aesthetic Medicine

Background:

• Hyaluronic acid (HA) dermal fillers are widely used in aesthetic medicine.
• Delayed inflammatory reactions (DIRs) are observed, particularly post-viral infection or vaccination.
• Immune activation is questioned in filler-related complications.

Purpose of the Study:

• Review literature on DIRs to HA fillers linked to viral illness or immunization.
• Analyze presentation and management of these reactions.
• Identify gaps in current knowledge and treatment.

Main Methods:

• Systematic literature search (PubMed, ScienceDirect, ClinicalKey, Google Scholar).
• Inclusion of human case reports and case series.
• Quality assessment using Newcastle-Ottawa Scale.

Main Results:

• Six publications (4 case series, 2 case reports) involving 25 women.
• Symptoms included swelling, erythema, angioedema, or facial edema post-HA injection.
• Onset ranged from hours to weeks after viral exposure; corticosteroids and hyaluronidase were common treatments.

Conclusions:

• DIRs to HA fillers post-viral events are uncommon but clinically relevant.
• Corticosteroids and hyaluronidase show potential efficacy, but management is inconsistent.
• Further prospective studies are needed for mechanisms and standardized guidelines.