Increase in the incidence of acute inflammatory reactions to injectable fillers during COVID‐19 era
Kiyoko Kato, Eiko Inoue, Sakae Tanaka, Hiroshi Kawamoto
Abstract
BACKGROUND: Acute inflammatory reactions (AIRs) are a rare complication following esthetic treatment with hyaluronic acid (HA) and/or human collagen fillers. However, a substantial increase in the frequency of AIRs was observed in the first author's clinic since May 2020. AIMS: To report AIR cases, we experienced and discuss potential underlying mechanisms. METHODS: This was a retrospective review of patients representing AIR symptoms following filler injection with HA or human collagen in our clinic. RESULTS: Although only one case of an AIR with an incidence rate of 0.01% was recorded following filler treatment between September 2008 and April 2020 in our clinic, we observed 14 AIR cases without anaphylaxis, with an incidence rate of 1.18% between May 2020 and June 2021, in line with the spreading of the new coronavirus pandemic. All cases were females aged 40-57 years, and the time of onset was within hours after filler injection. Three patients had been treated with HA fillers only, 2 with HA plus human collagen, and 9 with human collagen only. Most patients had been treated with these products in the past. Nine patients were treated with oral prednisolone. In all cases, symptoms resolved entirely within a week without sequelae. CONCLUSIONS: The marked increase in AIRs coincided with the COVID-19 pandemic. Possible explanations include immune system alterations caused by extensive changes in domestic and personal hygiene, prolonged and elevated stress levels, and subclinical COVID-19 infection. Further studies may be warranted.