Philipp-Dormston Wolfgang G, Goodman Greg J, De Boulle Koenraad, Swift Arthur, Delorenzi Claudio, Jones Derek, Heydenrych Izolda, Trindade De Almeida Ada, Batniji Rami K
Department of Dermatology, Witten/Herdecke University, Witten, Germany.
Klinik Links vom Rhein, Cologne, Germany.
Plast Reconstr Surg Glob Open. 2020 Apr 29;8(4):e2730. doi: 10.1097/GOX.0000000000002730. eCollection 2020 Apr.
Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies.
Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules.
The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described.
Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.
透明质酸（HA）填充剂的迟发性不良反应并不常见，但已受到越来越多的关注，尤其是迟发性结节。在全球范围内，需要全面的预防和管理策略。
来自世界不同地区且在管理与HA填充剂相关并发症方面具有丰富经验的临床专家齐聚一堂，提出并评估预防HA填充剂注射后迟发性不良反应及处理迟发性结节的方法。
专家小组同意将迟发性不良反应定义为治疗后4周以上出现的反应，肿胀、硬结和结节是最常见的临床症状。该小组推荐了5种预防迟发性反应的一般关键方法（患者选择、注射解剖位置/产品选择、无菌技术、注射操作/填充剂以及治疗后护理）。推荐用于处理迟发性结节的策略包括口服抗生素、口服类固醇、必要时使用非甾体抗炎药、用于非炎性结节的透明质酸酶（认识到这种治疗的局限性和地区可用性）、病灶内注射抗生素、病灶内注射免疫抑制药物如类固醇和氟尿嘧啶，以及作为最后手段的手术切除。该小组指出，迟发性结节在临床表现和病因方面可能各不相同，这使得处理或预防它们具有挑战性，并强调应根据临床表现进行个体化治疗。描述了无菌操作规范、抗生素选择和类固醇制剂方面的地区差异。
全球专家对预防和管理HA填充剂注射后迟发性不良反应（包括迟发性结节）方法的见解，有助于全球临床医生优化患者治疗效果和安全性。
