Making Sense of Late Tissue Nodules Associated With Hyaluronic Acid Injections

Author:

Goodman Greg J1ORCID,McDonald Cara B2,Lim Adrian3,Porter Catherine E4,Deva Anand K5,Magnusson Mark6ORCID,Patel Anita7,Hart Sarah8,Callan Peter9ORCID,Rudd Alice10,Roberts Stefania11,Wallace Katy12,Bekhor Philip13,Clague Michael14,Williams Linda15,Corduff Niamh16,Wines Nina17,Al-Niaimi Firas18,Fabi Sabrina G19,Studniberg Howard M20,Smith Saxon21,Tsirbas Angelo22,Arendse Sean23,Ciconte Antoinette24,Poon Terence20

Affiliation:

1. Honorary professor at the University College of London , London , United Kingdom

2. Dermatologist, St Vincent's Hospital Melbourne , Melbourne, Victoria , Australia

3. Practicing dermatologist, Department of Dermatology, Royal North Shore Hospital , St Leonards, New South Wales , Australia

4. Cosmetic physician in private practice in Sydney , New South Wales , Australia

5. Professor, Department of Plastic and Reconstructive Surgery, Macquarie University , Sydney , Australia

6. Associate professor, Department of Plastic and Reconstructive Surgery, Griffiths University Southport , Queensland , Australia

7. Dermatologist in Private practice in Bondi Junction , New South Wales , Australia

8. Aesthetic physician in private practice in Auckland , the North Island , New Zealand

9. Specialist plastic surgeon in private practice in Geelong , Victoria , Australia

10. Dermatologist, Department of Dermatology, Alfred Hospital Prahran Victoria , Victoria , Australia

11. Aesthetic physician in private practice in Melbourne , Victoria , Australia

12. Nurse practitioner at a private dermatology practice in South Yarra , Victoria , Australia

13. Dermatologist, Department of Paediatrics, University of Melbourne , Melbourne, Victoria , Australia

14. Cosmetic nurse in private practice in South Yarra , Victoria , Australia

15. Cosmetic physician in private practice in East Brisbane , Queensland , Australia

16. Plastic surgeon in private practice in Geelong , Victoria , Australia

17. Principal dermatologist in private practice in Sydney , New South Wales , Australia

18. Dermatologist, Department of Dermatology, Aalborg University , Aalborg , Denmark

19. Dermatologist, Department of Dermatology, University of California San Diego , La Jolla, CA , USA

20. Dermatologist in private practice in Sydney , New South Wales , Australia

21. Dermatologist at the Sydney Clinical School, ANU Medical School, College of Health and Medicine, Australian National University , Canberra, ACT , Australia

22. Oculoplastic surgeon in Sydney , New South Wales , Australia

23. Cosmetic physician in private practice in Melbourne , Victoria , Australia

24. Dermatologist at Eastern Health Hospital, Box Hill and Canterbury , Victoria , Australia

Abstract

Abstract Background The pathogenesis of delayed-onset tissue nodules (DTNs) due to hyaluronic acid (HA) injections is uncertain. Objectives To formulate a rational theory for DTN development and their avoidance and treatment. Methods A multidisciplinary and multicountry DTN consensus panel was established, with 20 questions posed and consensus sought. Consensus was set at 75% agreement. Results Consensus was reached in 16 of 20 questions regarding the pathogenesis of DTNs, forming the basis for a classification and treatment guide. Conclusions The group believes that filler, pathogens, and inflammation are all involved in DTNs and that DTNs most likely are infection initiated with a variable immune response. Injected filler may incorporate surface bacteria, either a commensal or a true pathogen, if the skin barrier is altered. The initially high molecular weight HA filler is degraded to low molecular weight HA (LMWHA) at the edge of the filler. Commensals positioned within the filler bolus may be well tolerated until the filler is degraded and the commensal becomes visible to the immune system. LMWHA is particularly inflammatory in the presence of any local bacteria. Commensals may still be tolerated unless the immune system is generally heightened by viremia or vaccination. Systemic pathogenic bacteremia may also interact with the filler peripheral LMWHA, activating Toll-like receptors that induce DTN formation. Given this scenario, attention to practitioner and patient hygiene and early systemic infection treatment deserve attention. Classification and treatment systems were devised by considering each of the 3 factors—filler, inflammation, and infection—separately. Level of Evidence: 4

Funder

The Australasian Society of Cosmetic Dermatologists

Publisher

Oxford University Press (OUP)

Subject

General Medicine,Surgery

Cited by 4 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3