Immediate Hypersensitivity Caused by the Mesotherapy

Mesotherapy, a procedure that involves the injection of substances like hyaluronic acid (HA) into the dermis and subcutaneous tissue for aesthetic purposes, is gaining popularity worldwide. In this study, we describe a patient with immediate hypersensitivity reaction after mesotherapy.

A 26-year-old woman presented to our clinic with chief complaint of multiple red nodules on the face. She received mesotherapy with NCTF 135 HA (Fillmed, France) 1 month ago, which was the second time for her to receive the injection of this material, and both injections were given via a syringe. While the first injection did not induce any discomfort, on the second night after the second injection, she noticed the formation of multiple nodules on the face, accompanied by swelling of the cervical lymph nodes without any pain or fever. Initially, she did not seek any treatment. But as there was improvement even after 2 weeks, she came to our clinic for a consultation. She reported no history of allergy or other illnesses. Physical examination showed multiple red solid nodules of around 0.1 cm × 0.1 cm in size on the face, with no itching, ulceration, or fever ([Fig. 1]). Laboratory tests did not show any abnormal results.

Fig. 1 Physical examination showed multiple red nodules on the face.

The patient was then diagnosed with immediate hypersensitivity and was suggested steroid therapy. One month later, the patient returned to the clinic for follow-up with improved symptoms.

Hypersensitivity reactions to HA injection are rare. HA is considered to have no organ or species specificity and is immunologically inert. However, evidence shows that HA may play a role in immunity by exhibiting pro- or anti-inflammatory properties depending on its size and location, as well as the receptors expressed in the neighboring cells. Especially low-molecular-weight HA may be proinflammatory and activate several macrophages through the CD44 cell surface receptors. In addition, HA can induce different immune responses depending on how deep it is injected. Thus, mesotherapy, in which low-molecular-weight HA is injected into the derma, may cause a higher risk of sensitization than other cosmetic HA injection methods. Immediate hypersensitivity reactions to HA can be due to either an immunoglobulin E–mediated immune response (type I hypersensitivity reaction) or CD4+ T-cell-mediated immune response (type IV hypersensitivity reaction). We recommend using a combination of a course of antihistamines and a short course of oral corticosteroids.

Publikationsverlauf

Accepted Manuscript online:
28. November 2023

Artikel online veröffentlicht:
15. Januar 2024