Patient factors influencing dermal filler complications: prevention, assessment, and treatment

Figures & data

Table 1 Conditions contraindicating or warranting caution in the use of dermal fillers

Condition	Examples or comment	CI	PD	NAC
Active skin infection	Impetigo, herpes simplex, massive demodex folliculorum, pityrosporum, Propionibacterium acnes, viral warts	X
Inflammatory conditions of the skin	Atopic patients, allergic contact dermatitis, “status cosmeticus” or sensitive skin syndrome, seborrheic dermatitis, active lichen planus, active acne rosacea		X
Other inflammatory diseases	Pyoderma Osteoarthritis		X
Active localized infection	Ear, nose, or throat infections, dental abscess, periodontitis	X
Active generalized infection	Gastroenteritis, urinary bladder infection	X
Noninfectious gastrointestinal conditions	Crohn’s disease, ulcerative colitis		X
Allergy/hypersensitivity	Hypersensitivity to filler components including lidocaine, chronic urticaria, and Quincke’s edema	X
Active psoriasis arthropatic	If condition is more arthropatic: caution warranted If condition is more psoriatic than arthropatic: treatment is possible		X	X
Systemic infections: viral	HIV		X
Conditions potentially causing a Koebner response	Lichen planus, lichen nitidus, or lichen sclerosus, psoriasis, viral warts		X
Active collagenoses	Mixed connective tissue disease Active morphea, active systemic lupus	X
Other collagenoses	Marfan syndrome, Ehlers–Danlos syndrome		X
	Stabilized morphea			X
Immune compromise	Graft versus host disease	X
Immune compromise	Bullous diseases		X
Autoimmune conditions	Active Hashimoto’s disease Mixed connective tissue disease	X
Autoimmune conditions	Dermatomyositis/polymyositis, lupus erythematosus, rheumatoid arthritis		X
Transplant patients Immunosuppressive therapy	Heart, kidney, liver, bone marrow transplant: beware of increased risk of infections		X
Thyroid dysfunction	Not a contraindication to treatment, but physician needs to be aware that eyelid swelling is common (unrelated and unprovoked by filler use)		X
Metabolic disorders	Diabetes, porphyria			X
Catabolic status		X
Cachexic state	Does not contraindicate treatment, but product may be more visible in patients who lack subcutaneous fat and have thin tissue coverage		X
Conditions affecting skin pigmentation	Melasma and post-inflammatory hyperpigmentation		X
Skin pigmentation/depigmentation	Fitzpatrick Types 5 and 6 skin, vitiligo, and albinism			X
Systemic infections: bacterial	Tuberculosis	X
Active anticoagulant medication	Thrombolytics	X
Hemostatic or coagulation disorders	Hemophilia, hemoglobin pathology, thalassemia	X
Cutaneous collagenoses	Chronic discoid lupus erythematosus, active but not end-stage scleroderma		X
Food intolerance			X
Bariatric gastric sleeve surgery	Potentially reduced time of esthetic effect			X

Abbreviations: CI, contraindicated; PD, treat at physician’s discretion; NAC, no apparent contraindication.