Delayed immune-mediated adverse effects related to hyaluronic acid and acrylic hydrogel dermal fillers: clinical findings, long-term follow-up and review of the literature
Delayed immune-mediated adverse effects related to hyaluronic acid and acrylic hydrogel dermal fillers: clinical findings, long-term follow-up and review of the literature
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DOI：
10.1111/j.1468-3083.2007.02354.x
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发表时间：
2008-02-01
影响因子：
9.2
通讯作者：
Garda-Gimenez, V.
中科院分区：
文献类型：
--
作者：
Alijotas-Reig, J.;Garda-Gimenez, V.
前言为美容目的植入真皮填充物在世界范围内正变得越来越普遍。一般认为透明质酸(HA)单独或与丙烯酸水凝胶(HA-AH)联用无严重或持续性副作用。目的评价与HA和HA-AH填充物相关的延迟性不良反应患者的临床主诉、实验室资料、治疗和随访情况。设计前瞻性的病例系列研究，对HA和HA-AH复合体填充物的患者进行前瞻性、病例系列研究。纳入标准已经制定。有直接副作用的患者被排除在外。患者接受了临床随访、一系列血液测试和胸部X光检查。此外，还对相关文献进行了综述。从1996年到2005年12月，我们进行了一项计算机辅助(MEDLINE)，美国马里兰州贝塞斯达国家医学图书馆的文献检索。主要结果临床评价肉芽肿、皮肤表现和其他可能与HA和HA-AH填充物有关的局部和系统免疫介导性疾病或它们与以前给药的填充物的累积相互作用。结果25例患者中，16例单独填充HA，9例填充HA-AH化合物。在15例分析和长期随访的病例中，10例仅填充HA，其余5例填充HA-AH。平均潜伏期13.7个月。在这15个病例中，有3个以前填充过硅胶，1个填充过Artecoll。14例可见压痛结节。3例出现全身症状。所有研究病例均发现实验室异常。经过16个月的平均随访，7名患者似乎痊愈，6名患者复发。结论虽然在某些情况下，这些临床并发症可能与以前的填充物或其他不明原因的异物有关，但我们认为，尽管不常见，延迟和复发的慢性炎症和肉芽肿性反应可能会使HA和HA-AH植入物的填充物复杂化。
Introduction Implantation of dermal filler for cosmetic purposes is becoming increasingly common worldwide. It is thought that hyaluronic acid (HA) alone or combined with acrylic hydrogels (HA-AH) does not have severe nor persistent side-effects. However, recent evidence may show that major, local and/or systemic, immediate or delayed adverse effects may appear in relation with its use.Objective To evaluate the clinical complaints, laboratory data, treatment and follow-up of patients with delayed adverse effects related to HA and HA-AH implant fillers.Design Prospective, case-series study of patients filled with HA and HA-AH compounds.Setting The study has been done in a tertiary, teaching university hospital.Patients We report on a series of 25 patients, 15 of them in prospective manner, with severe, delayed side-effects related to HA-AH. Inclusion criteria have been drawn up. Patients with immediate side-effects were excluded. Patients were submitted to a clinical follow-up, battery of blood tests and thorax X-ray films. Besides, a review of the literature was made. We undertook a computed-assisted (MEDLINE), National Library of Medicine, Bethesda, MD, USA, search of the literature from 1996 up to December 2005.Main outcome Clinical evaluation of granulomas, skin manifestations and other local and systemic immune-mediated disorders possibly related to HA and HA-AH fillers or their cumulative interaction with previously administered fillers.Results Of 25 cases, 16 were filled with HA alone and 9 with a HA-AH compounds. Of 15 cases analysed and with long-term follow-up, 10 were filled with HA alone, and the remaining five were filled with a HA-AH. Time latency average up to beginning of symptoms was 13.7 months. Three of these 15 cases had been filled before with silicone and another one with Artecoll. Tender nodules were seen in 14 patients. Systemic manifestations appeared in three cases. Laboratory abnormalities were noted in all studied cases. After 16-month average follow-up, seven patients seem to be cured, and six have recurrent bouts. Two cases were lost during follow-up.Conclusion Although in some cases, these clinical complications might have been associated with previous fillers or with other unknown foreign bodies, we feel that, although infrequently, delayed and recurrent chronic inflammatory and granulomatous reactions may complicate HA and HA-AH implant fillers.