Annals of Medical and Surgical Dermatology

ABSTRACT

During the COVID-19 pandemic, an unexpected issue emerged among patients who had previously received cosmetic dermal fillers. Reports surfaced of delayed-onset swelling, nodules, and other inflammatory reactions following mRNA-based vaccines like Moderna and Pfizer and the viral vector AstraZeneca vaccine. Although rare, these side effects raised concerns within the medical and cosmetic industries. Initially, the complications were thought to result from a Type IV hypersensitivity reaction an immune system response to what it recognized as foreign material, such as fillers [1]. While treatments such as antihistamines, hyaluronidase, and intralesional steroids were attempted, many patients experienced only limited or temporary relief. Some presented with severe cases, including clusters of multiple hard nodules in areas treated with fillers, causing significant cosmetic and psychological distress [2]. These challenges have left healthcare providers and dermatologists questioning: How should these vaccine-associated filler reactions be managed effectively? Are current treatment protocols enough to address these complications? With more patients receiving booster doses, the problem has grown, highlighting the need for better solutions. In this context, methotrexate, a chemotherapy agent with immunosuppressive properties has emerged as a potential treatment option.

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