Avaliação das reações cutâneas ao preenchimento dérmico após a COVID-19 e/ou vacinação contra o vírus SARS-CoV-2

Abstract

Minimally invasive cosmetic treatments have grown at a surprisingly high rate of 174% over the past 20 years. Dermal fillers rank second among the most commonly performed aesthetic procedures worldwide. With the increased use of injectable fillers, concerns about adverse events have also grown. During the COVID-19 pandemic, reactions were observed in body areas containing fillers, associated with the disease itself and vaccination against SARS-CoV-2. This study aimed to evaluate, through a systematic review of the medical literature, these cutaneous reactions at filler sites related to COVID-19 and/or SARS-CoV-2 vaccines in patients with a history of injectable filler use. This systematic review was registered in PROSPERO (CRD42024595785). A search for studies was conducted in the PubMed/MEDLINE, EMBASE, SCIELO, and LILACS databases, covering the period from December 2019 to September 2024. Two researchers conducted the search simultaneously and independently. Any disagreements were resolved by consensus. Study selection occurred in two stages: title and abstract screening, followed by fulltext review. Validated tools were used to assess study quality and risk of bias. Among the 35 eligible articles according to inclusion and exclusion criteria, 25 were case reports, 7 case series, and 3 retrospective studies. A total of 79 patients experienced adverse reactions after COVID-19 or SARS-CoV-2 vaccination, with 77 being female. Patients ranged in age from 23 to 76 years. Most adverse events occurred after vaccination (62; 78.48%), while the remainder followed COVID-19 infection (18; 22.78%). Nearly all types of SARS-CoV-2 vaccines were reported as potential triggers for these events. The most commonly cited filler was hyaluronic acid (HA), used alone in 65 patients (82.3%). In 6 patients (7.6%), HA was used in combination with other products. Additionally, 3 patients (3.8%) received PMMA, 2 (2.55%) PAAG, 1 (1.25%) CaHA, 1 (1.25%) liquid silicone, and 1 (1.25%) PCL. The two most mentioned HA brands were Juvederm by Allergan (16/79; 20.25%) and Restylane by Galderma (7/79; 8.86%). Most patients experienced localized reactions at the filler site, with edema being the most frequent presentation. The reactions were predominantly transient and self-limiting, with or without treatment, and carried a low risk of sequelae. It is still not possible to predict which individuals with injectable fillers will develop reactions following COVID-19 infection and/or SARS-CoV-2 vaccination. Despite the morbidity, mortality, and socioeconomic impact caused by the COVID-19 pandemic, vaccination should continue to be encouraged. However, further research on adverse events related to vaccines and viral infections is needed to clarify mechanisms and risk factors that may guide clinical decisions before aesthetic procedures and the management of adverse events if they occur.