Aesthetic procedures that break the integrity of the skin are associated with a small risk of complications, including scarring, which is a consequence of the reactivation of the herpes simplex virus. The appearance of a herpetic rash on the face is usually caused by HSV-1, and only in 10% of cases – HSV-2. Often, the primary infection provoked by HSV-1 is asymptomatic, while its recurrence is characterized by the appearance of vesicles on the red border of the lips. Although herpes does not cause long-term skin damage, it can cause scarring in the infected area. How to prevent this, says Dr. Cormac Convery.
Which aesthetic procedures can provoke the reactivation of the herpes simplex virus
Herpetic rash can cause discomfort (both physical and psychological), pain and scarring in the sensitive area. The following aesthetic procedures can provoke the reactivation of the herpes simplex virus:
- laser therapy;
- mesotherapy;
- chemical peels;
- microdermabrasion;
- filler injections, etc.
Tissue manipulation, controlled traumatic skin injuries are considered the main causes of HSV reactivation, which, for example, in the case of fillers, is observed at the injection site (most often - in the nasolabial folds and around the mouth). In some cases, there is a lesion of the adjacent area of the face.
Manipulations with tissues, controlled traumatic skin lesions are considered the main causes of HSV reactivation.
The appearance of herpetic eruptions, as a rule, is observed within 24-48 hours after the introduction of the filler. However, it should be noted that the incidence of this complication remains minimal – only 1.45% of all lip corrections with dermal fillers (according to FDA).
Minimizing the risks associated with reactivation of the herpes simplex virus
The practitioner should understand how important it is not only to be aware of the risk of reactivation of the herpes simplex virus, but also to assess the likelihood of this problem depending on the procedure performed and the patient's history.
In order to eliminate the small but still existing possibility of scarring after aesthetic procedures, it is necessary to take appropriate preventive measures.
Based on the results of studies evaluating the effectiveness of methods for preventing recurrence of HSV infection, experts recommend that patients be given prospective antiviral therapy before laser skin resurfacing procedures.
The aesthetic practitioner should be aware of the importance of minimizing the risk of herpes simplex virus reactivation.
Despite the limitations of the studies, the results have shown that prophylactic antiviral therapy is an effective way to reduce the risk of HSV reactivation.
It is worth noting that studies aimed at evaluating methods for preventing HSV reactivation after mesotherapy have not been conducted; and existing recommendations are designed for laser procedures, so care must be taken when applying them for other manipulations.
Prevention of Herpes Simplex Virus Infections: ACE Protocol
The Aesthetic Complications Management (ACE) Panel has developed a protocol for the prevention of herpes simplex infections, which provides recommendations for prescribing prophylactic therapy in the following cases:
- more than three cases of herpetic eruptions per year;
- previous cases of rashes after aesthetic procedures;
- appearance of herpetic fever after injectable lip augmentation;
- skin rejuvenation procedures, including those aimed at whitening, using medium or deep peels, fractional lasers, mesotherapy, microdermabrasion;
- a weakened immune system in a patient.
Aciclovir 400 mg twice daily (or 3 times in immunocompromised or at-risk patients) is recommended as first-line prophylaxis by the expert panel. Valaciclovir 500 mg once daily (twice daily in immunocompromised or at-risk patients) is recommended as second-line therapy.
Read also: Troubles and dangers due to the herpes simplex virus
Despite its relatively low incidence, post-aesthetic scarring associated with HSV reactivation cannot be ignored. A careful history taking and proper preventive measures will help eliminate this risk and make the procedure safer for the patient.
Adapted from Aesthetics.
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