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case_images: The patient after three weeks of treatment: the inflammation has subsided. However, the lesions are still visible.
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case_images: The lesions were tender on palpation (Figure 1).
case_images: HA deposit appeared as a dark hypoechoic region with well-defined contours in the subcutaneous tissue of the left zygomatic region.
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case_images: The ultrasound examination revealed HA deposits appeared as a dark hypoechoic region with well-defined contours in the subcutaneous tissue of the left zygomatic region (Figure 2).
case_images: The patient after one year of treatment, the third day after the withdrawal of prednisone 2.5 mg. (red arrows - sites of oedema).
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case_images: After administering 2.5 mg of prednisone once again, the lesions subsided (Figure 3).
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case_images: (A) After 3 y of BTX /collagen fillers. (B) After 10 years of BTX and fillers.
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case_images: In the 3 first years, she has been treated with a collagen-based product (Evolence and Evolence Breeze) (Figure 4A and B).
case_images: Signs of cyclic massive swelling over all injected areas.
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case_images: This edematous swelling shows a more or less cyclic course (Figure 5).
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case_images: (A) Before treatment with HA. (B) 1 week after injection.
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case_images: She got a cosmetic treatment since 2014 with hyaluronic acid for a full-face treatment (total of 5 cc HA). (Figure 6A) Her main medication at that time consisted of adalimumab. She left the office uneventful, but a couple of days complained of a flu-like condition (possibly already on the day of treatment) and a little over 1 week later she presented with massive swelling, periorbital edema and hard infiltrate of all HA injected areas (Figure 6B).
case_images: Positive intradermal testing.
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case_images: The products used for the facial treatment have been injected in the ventral side of the forearm: 2 weeks later a serious local reaction could be noted, suggesting a real hypersensitivity for one compound and a lesser reaction to the other product used (Figure 7).