Sociedade Brasileira de Dermatolodia Surgical & Cosmetic Dermatology


ISSN-e 1984-8773

Questoes e Gabaritos

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Adverse events in injectable hyaluronic acid


1. About Hyaluronic Acid (HA),which of the following
is incorrect to state:
a. it is present in the extracellular matrix of connective tissues, synovial fluid, aqueous, and vitreous humors
b. it forms the elastoviscous fluid matrix that surrounds collagen and elastic fibers, as well as intercellular structures
c. its concentration in the skin tends to decrease with age
d. it consists of polysaccharides and glycosaminoglycans
e. it is a permanent gel
2. About HA, it is correct to state that:
a. it has a low molecular weight
b. it is lipophilic
c. the crosslinking technique is aimed at reducing the duration of the filler
d. through crosslinking, molecules that interlink to HA produce macromolecules that have the same biocompatibility yet are less stable and provide less reabsorption
e. it can be derived from cocks’ combs or synthetically produced (from the bacterial fermentation of Streptococcus spp)
3. All are indications for the use of HA, except for:
a. correction of rhytids
b. paralysis of muscles in the upper third of the face
c. increase in lip volume
d. correction of acne scars
e. correction of folds
4. All are contraindications to HA-based cutaneous filling,
except for:
a. pregnancy
b. autoimmune disease
c. use of aminoglycoside
d. severe immunodeficiency
e. breastfeeding
5. Complications arising from the use of HA may derive
from several factors, except for:
a. neurological disorders
b. lack of experiences
c. incorrect technique
d. product used
e. lack of patient skin antisepsis
6. Which of the following is not a possible adverse reaction
to HA filling:
a. erythema
b. edema
c. necrosis
d. melasma
e. hematoma
7. About adverse events linked to the use of HA, mark
the incorrect option:
a. erythema is a rare complication that improves in a few hours or days
b. hematomas are caused by vessel perforation or rupture secondary to compression
c. treatment of bleeding can be carried out with local pressure and, if necessary, cauterization
d. ecchymosis tends to improve in 5-10 days
e. necrosis is a rare and serious complication
8. Regarding necrosis associated with the use of HA,
which of the following is incorrect:
a. it is caused by local compression or accidental intra-arterial injection
b. the most common sites are the glabella and the nasal ala
c. the patient usually feels no pain and there is no change in the color of the skin
d. warm compresses, 2% nitroglycerin cream, and local hyaluronidase injections are treatment options for tissue necrosis
e. venous occlusions usually emerge later on
9. Mark the incorrect option regarding infections related
to HA-based cutaneous filling:
a. they are probably caused by product contamination or lack of asepsis
b. they are very frequent
c. they can have bacterial or viral origin
d. routine herpes prophylaxis is not recommended
e. mycobacteriosis may occur
10. Mark the correct option:
a. nodules may occur primarily as a result of excessive superficial applications of HA in the skin
b. early papules always have the same color, and never improve
c. in late nodules, it is usually possible to observe the formation of foreign body granulomas in a histological examination
d. granulomas may require treatment with hyaluronidase and, in extreme cases, surgical removal
e. allergic reactions can be treated with oral or intralesional corticosteroids

Gabarito do número anterior

1. C 2. D 3. C 4. E 5. B 6. A 7. A 8. B 9. C 10. E

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