Dermal fillers, more often – based on hyaluronic acid, are widely used in clinical practice to eliminate aesthetic defects. Quite common adverse events after contouring, as a rule, disappear after a few days. These include, for example, swelling, itching, hematomas. Less common cases of allergic reactions, vascular embolism, as well as activation of the herpes virus.
Due to their inexperience, many cosmetologists do not take into account the risk of reactivation of the herpes virus after injections of hyaluronic acid. At the same time, it is very important to apply adequate measures for the prevention, diagnosis and treatment of this complication.
How to do this, we will consider in the article estet-portal.com on the example of a case from the practice of doctors Chenyu Wang, Yianyu Sun, Nanze Yu, Xiaojun Wang.
- Case report: herpes after hyaluronic acid injections
- Etiology and symptoms of herpes virus reactivation
- Diagnosis of herpetic infection after contouring
- Herpes treatment: a review of therapeutic approaches
- Prevention of herpes virus reactivation after administration of HA fillers
Case report: herpes after hyaluronic acid injections
A female patient (24 years old) came to the authors' clinic with complaints of the following symptoms in the nasal area:
- redness;
- papules covered with a crust;
- painful sensations;
- edema.
The symptoms bothered the patient for 4 days.
Previously, the patient had a nose correction with a hyaluronic acid filler. A day after the injection, vesicles, edema, erythema and papules appeared in the treated area.
Patient 4 days after hyaluronic acid injections
At the author's clinic, the patient was swabbed with secretions from the affected area and cultured, during which herpes simplex virus was detected.
The patient had no history of herpetic diseases, so the specialist did not prescribe prophylactic therapy before the filler injection.
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The authors prescribed treatment according to the scheme: 400 mg of acyclovir 3 times a day for 7 days. After a week, symptoms were reduced.
Symptoms and etiology of herpes virus reactivation
Active replication of the virus and the body's immune response in most cases lead to an acute course of infection, the symptoms of which are quite pronounced. These include:
- edema;
- erythema;
- local soreness;
- appearance of a crust on the vesicles.
The severity of symptoms decreases as the viral load decreases. However, the resolution of symptoms does not always indicate the absence of the – sometimes the infection is asymptomatic with subsequent exacerbations.
The risk of herpes virus reactivation after injections of dermal fillers is low: HSV-1 – in less than 1.45% of cases, and herpes zoster – even rarer.
Provoke the reactivation of the herpes virus and herpetic fever after hyaluronic acid, according to the author, can:
- local injury – direct axon injury with a needle and tissue manipulation after filler injection;
- inflammatory reaction after filler injection;
- systemic stress or immunosuppression.
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As a rule, the symptoms of a viral infection appear in the area of filler injection, more often – around the mouth and nasolabial folds, through 24 – 48 hours after hyaluronic acid injection. In some cases, symptoms spread to neighboring areas.
Diagnosis of herpetic infection after contouring with fillers
It is necessary to differentiate between reactivation of the herpes virus and an acute allergic reaction. Acute allergic reactions to HA usually develop within 24 hours after injection and manifest mainly as local inflammatory or non-inflammatory edema at the injection site, local skin changes, etc.
Histopathological examination with hematoxylin-eosin is usually not sufficient to confirm the diagnosis. Virus culture, which is still considered the gold standard, is time consuming and has lower sensitivity than other methods. The Zank test for HSV and varicella-zoster is quick and easy to perform in a clinical setting and, if positive, allows a rapid diagnosis of viral infection.
Herpes treatment: an overview of therapeutic approaches
For the treatment of herpes simplex infection when symptoms are present, use:
- acyclovir;
- valaciclovir;
- Famciclovir
Approaches to the treatment of herpesvirus infection can be divided into three groups: episodic relapse therapy (ETR), chronic suppressive therapy (CST) and episodic suppressive therapy (ECT).
Read also: Herpes on the lips after cosmetic procedures: prevention and treatment
ETR is administered during exacerbations of a chronic disease, XST – with frequent relapses with severe functional disorders and defects, and ECT – for the prevention of oral and genital herpes.
For HSV outbreaks, give:
- 400 mg acyclovir (3 times a day for 10 days); or
- 1 g valaciclovir hydrochloride (2x every day for 7 days).
Prevention of reactivation of the herpes virus after the introduction of HA fillers
Before performing the procedure, the cosmetologist should carefully study the patient's history, paying attention to symptoms that may indicate previous outbreaks of HSV (vesicles, erythema, desquamation).
Properly performed clinical examination and follow-up of the patient after injection correction play an important role in the prevention and effective treatment of herpes infection.
Prophylactic oral therapy is recommended for patients with a history of herpes or a weakened immune system:
- 400 mg aciclovir 3 times a day for 10 days; or
- 1 g valaciclovir 2 times a day for 7 days.
Reactivation of herpes after hyaluronic acid injections – quite a rare complication, & nbsp; which the cosmetologist needs to know and remember in order to ensure proper prevention, diagnosis and treatment of herpes virus infection, if necessary.
Adapted from Medicine.
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