{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:09:06Z","timestamp":1785406146028,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lithuanian University of Health Sciences science fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Hyaluronic acid (HA) dermal fillers are among the most widely used injectable materials in esthetic medicine. They are generally safe, but delayed inflammatory reactions (DIRs) have been observed, particularly after viral infections or vaccinations. Such events have raised questions about the role of immune activation in filler-related complications. This review examined the available literature on DIRs to HA fillers that occurred in the context of viral illness or immunization, with attention to how these reactions present and how they are managed. Materials and Methods: A systematic search was carried out in PubMed, ScienceDirect, ClinicalKey, and Google Scholar between October and November 2024. Only human case reports and case series were included. The protocol was registered in PROSPERO (CRD420251030918), and study quality was assessed using the Newcastle\u2013Ottawa Scale. Results: Six publications met inclusion criteria: four case series and two case reports, describing 25 women between 22 and 65 years of age. Patients developed swelling, erythema, angioedema, or, in severe cases, marked facial edema after HA filler injections, with symptom onset ranging from several hours to several weeks following viral exposure. Corticosteroids and hyaluronidase were the most common treatments, though milder cases sometimes resolved without intervention. Study quality varied, with some reports providing limited detail on patient characteristics and follow-up. Conclusions: DIRs associated with viral infections or vaccinations remain uncommon but clinically relevant complications of HA filler use. Limited case-based evidence indicates potential effectiveness of corticosteroids and hyaluronidase, though management practices remain inconsistent. Larger prospective studies are needed to clarify underlying mechanisms and to establish standardized guidelines for treatment.<\/jats:p>","DOI":"10.3390\/medicina61101764","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T12:59:46Z","timestamp":1759150786000},"page":"1764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Systematic Review of Post-Viral Delayed Inflammation Associated with Hyaluronic Acid Dermal Fillers"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7938-6801","authenticated-orcid":false,"given":"Lorena","family":"Bhatia","sequence":"first","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saja","family":"Al Rekabi","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2749-1495","authenticated-orcid":false,"given":"Audra","family":"Janovskien\u0117","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3300-8030","authenticated-orcid":false,"given":"Inesa","family":"Stonkut\u0117","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-9626","authenticated-orcid":false,"given":"Dainius","family":"Razukevi\u010dius","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justina","family":"Stu\u010dinskait\u0117-Mara\u010dinskien\u0117","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2019). The American Society for Aesthetic Plastic Surgery\u2019s Cosmetic Surgery National Data Bank: Statistics 2018. Aesthet Surg. J., 39, 1\u201327.","DOI":"10.1093\/asj\/sjz164"},{"key":"ref_2","unstructured":"(2025, April 09). Market Research Future. Hyaluronic Acid-Based Dermal Filler Market Size, Share & Trends Analysis Report by Application (Wrinkle Removal, Lip Augmentation, Rhinoplasty), Product, Region, and Segment Forecasts, 2024\u20132030. Published 2024. Available online: https:\/\/www.marketresearchfuture.com\/reports\/hyaluronic-acid-based-dermal-filler-market-42755."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e15453","DOI":"10.1111\/dth.15453","article-title":"Evaluating hyaluronic acid dermal fillers: A critique of current characterization methods","volume":"35","author":"Wongprasert","year":"2022","journal-title":"Dermatol Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1001\/archderm.138.11.1454","article-title":"Relative contribution of intrinsic vs extrinsic factors to skin aging as determined by a validated skin age score","volume":"138","author":"Guinot","year":"2002","journal-title":"Arch. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s00266-003-3022-1","article-title":"Human histology and persistence of various injectable filler substances for soft tissue augmentation","volume":"27","author":"Lemperle","year":"2003","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"369","DOI":"10.2147\/CIA.S1244","article-title":"Use of hyaluronic acid fillers for the treatment of the aging face","volume":"2","author":"Gold","year":"2007","journal-title":"Clin. Interv. Aging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1055\/s-0041-1724122","article-title":"Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review","volume":"37","author":"Trinh","year":"2021","journal-title":"Facial Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1055\/s-0035-1544924","article-title":"Injectable fillers: Review of material and properties","volume":"31","author":"Attenello","year":"2015","journal-title":"Facial Plast. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1002\/bip.1968.360060603","article-title":"Rheology of hyaluronic acid","volume":"6","author":"Gibbs","year":"1968","journal-title":"Biopolymers"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.asj.2004.04.009","article-title":"Understanding and using hyaluronic acid","volume":"24","author":"Matarasso","year":"2004","journal-title":"Aesthet Surg. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/j.1473-2165.2007.00331.x","article-title":"Persistent delayed-type hypersensitivity reaction to injectable non-animal-stabilized hyaluronic acid","volume":"6","author":"Arron","year":"2007","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00403-021-02190-6","article-title":"COVID-19\/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: A challenging clinical conundrum in diagnosis and treatment","volume":"314","author":"Munavalli","year":"2022","journal-title":"Arch. Dermatol. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2147\/CCID.S198081","article-title":"Delayed hypersensitivity reaction to hyaluronic acid dermal filler following influenza-like illness","volume":"12","author":"Turkmani","year":"2019","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.2310\/6350.2005.31250","article-title":"Adverse reactions to dermal fillers: Review","volume":"31","author":"Lowe","year":"2005","journal-title":"Dermatol. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1473-2130.2004.00058.x","article-title":"Management of complications after implantation of fillers","volume":"3","year":"2004","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1111\/j.1524-4725.2009.01347.x","article-title":"Electron microscopic documentation of late changes in permanent fillers and clinical management of granulomas in affected patients","volume":"35","author":"Wiest","year":"2009","journal-title":"Dermatol. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"232","DOI":"10.5999\/aps.2015.42.2.232","article-title":"Foreign body granulomas after the use of dermal fillers: Pathophysiology, clinical appearance, histologic features, and treatment","volume":"42","author":"Lee","year":"2015","journal-title":"Arch. Plast. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1111\/jocd.14312","article-title":"Hyaluronic acid soft tissue filler delayed inflammatory reaction following COVID-19 vaccination\u2014A case report","volume":"20","author":"Michon","year":"2021","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1111\/jocd.14970","article-title":"Hyaluronic acid delayed inflammatory reaction after third dose of SARS-CoV-2 vaccine","volume":"21","author":"Calvisi","year":"2022","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ijid.2021.09.066","article-title":"Hypersensitivity reaction to hyaluronic acid dermal filler after the Pfizer vaccination against SARS-CoV-2","volume":"113","author":"Savva","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1007\/s43678-022-00289-x","article-title":"Delayed inflammatory reaction to dermal fillers after COVID-19 vaccination: A case report","volume":"24","author":"Beamish","year":"2022","journal-title":"Can. J. Emerg. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1764\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T11:32:18Z","timestamp":1766489538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["medicina61101764"],"URL":"https:\/\/doi.org\/10.3390\/medicina61101764","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]}}}