This paper describes a lip filling technique that administers hyaluronic acid using microcannulas. This technique considerably reduces the number of punctures compared to the conventional method, which uses needles. In addition, the microcannula’s blunt tip reduces the risks of intravascular injection of the substance and of disrupting key structures such as vessels and nerves. The results obtained by the authors confirm the less frequent occurrence of adverse effects and a high degree of physician and patient satisfaction.

Keywords: HIALURONIC ACID, LIP, REJUVENATION

Hyaluronic acid is the currently most used filler in dermatology due to its low risk of adverse events. The objective of this study is to report a case of granulomatous reaction after filling with two types of hyaluronic acid, in the perioral region and in the nasolabial folds. A female patient with rheumatoid arthritis treated with leflunomide presented onset of symptoms 30 months after filling. Autoimmune diseases may facilitate the occurrence of complications and should be followed carefully before filling with hyaluronic acid. As already reported with the use of interferon and omalizumab, granulomatous reaction to fillers may occur after use of leflunomide.

Keywords: HYALURONIC ACID; GRANULOMA; RHEUMATOID ARTHRITIS; FOREIGN-BODY REACTION

Herpes zoster outbreaks following minor procedures have been documented recently in literature. Since the use of botulinum toxin is nowadays spread in several medical areas for different purposes, it is crucial to study its side effects and complications. Literature review revealed 65 cases of zoster reactivation following minor procedures, and three cases related to BTA injections (two for facial lines treatment and one for chronic migraine). In our case, a 43 year old healthy woman had herpes zoster on the face and scalp after receiving BTA injections for cosmetic purpose, with complete recovery after anti-viral treatment.

Keywords: HERPES ZOSTER OPHTHALMICUS; HERPES ZOSTER; BOTULINUM TOXINS, TYPE A; DERMATOLOGIC SURGICAL PROCEDURES

INTRODUCTION: Lysine is one of the essential amino acids, with a role in the prophylaxis of recurrent orolabial herpes simplex that has been demonstrated in scientific studies. Facial resurfacing procedures with laser and other technologies can reactive herpes simplex.
OBJECTIVE: To evaluate the incidence of cases of orolabial herpes in patients submitted to treatments with fractional ablative and non-ablative lasers and robotic microneedling, under prophylactic l-lysine.
METHODS: A sample of 100 was selected to have prophylactic l-lysine for herpes simplex. A re-evaluation of all patients was conducted seven days after laser treatment. If herpes infection was detected, doses of oral antiviral similar to those used for herpes-zoster treatment would be prescribed, guided by the literature.
RESULTS: Only 2% of the sample demonstrated herpes simplex after the procedure with prophylactic l-lysine. Both patients underwent ablative fractional laser treatment and had past history of herpes simplex infection.
CONCLUSIONS: Besides the low cost, l-lysine is a natural product that proved to be safe and effective for the prophylaxis of herpes simplex in resurfacing procedures, with a similar or lower rate of viral activation to the use of antivirals.

Keywords: Herpes Simplex; Herpes Labialis; Lysine; Laser Therapy; Lasers

Filler-induced arterial obstruction can mimic other dermatological conditions. In this case series, the authors describe four patients with filler-induced arterial obstruction presenting with pustular rash that was misdiagnosed as a herpetic infection. Since correct and timely diagnosis is crucial for scar prevention, pustular rash has to be recognized by injectors as a clinical expression of vascular obstruction induced by dermal filler injection.

Keywords: Hyaluronic acid; Herpes simplex; Ischemia; Injections, intra-arterial

Riziform bodies are structures in the synovial fluid or attached to the synovium, which macroscopically resemble rice grains. They are common in patients with rheumatoid arthritis and result from a chronic inflammation. They are found in 25% of aspiration procedures or joint surgery. However, there are still no publications reporting its presence in the subcutaneous tissue. We report for the first time the occurrence of riziform bodies in the subcutaneous plane of the palmar region in a patient with rheumatoid arthritis, confirmed by sonographic and anatomopathological examination, successfully treated with surgical drainage, without recurrences after two years of follow-up.

Keywords: Abscess; Rheumatoid arthritis; Dermatopathies; Hand dermatoses; Outpatient Surgical Procedures; Surgical Diagnostic Techniques