Aesthetic interventions in patients with allergic skin diseases: Risk assessment and evidence-based preventive risk...

The use of aesthetic dermatologic procedures in patients with underlying allergic and inflammatory skin diseases is on the rise, but specific safety considerations are often overlooked. Individuals with hypersensitivity to injectables, chronic inducible urticaria, allergic contact dermatitis, atopic dermatitis, or hereditary angioedema may face an increased risk of adverse reactions triggered by mechanical trauma, injected substances, or disruption of the skin barrier. Adverse reactions to local anesthetics are predominantly non-IgE-mediated. Thus, preventive strategies should focus on selecting the appropriate agents and employing proper injection techniques rather than routine pharmacologic prophylaxis. Botulinum toxin, hyaluronic acid fillers, and hyaluronidase can rarely cause immediate or delayed hypersensitivity reactions. This highlights the need for individualized risk assessment and avoidance of reexposure in confirmed cases. For patients with chronic inducible urticaria, aesthetic procedures can act as physical triggers. Ensuring optimal disease control with preprocedural antihistamines may help reduce this risk. In cases of allergic contact dermatitis and atopic dermatitis, a compromised skin barrier and exposure to device-related allergens may heighten the chances of developing eczematous or infectious complications. Patients with hereditary angioedema require short-term prophylaxis, preferably utilizing C1-inhibitor therapy. With careful evaluation and tailored preventive strategies, aesthetic dermatologic procedures can be performed safely in patients with allergic and inflammatory skin conditions.