Livedo Reticularis and Skin Necrosis Due to Hyaluronic Acid Embolism

Skin Necrosis from Intra-articular Hyaluronic Acid Injection

“…1 There has been one case report of skin necrosis following IA HA injection, but cases of tissue necrosis in the glabellar or alar region of the face following HA filler injection for cosmetic purposes are well documented. 1,9 The pathophysiology of this adverse effect is not fully understood; however, similar to the mechanism by which facial fillers cause cutaneous necrosis, it is hypothesized that the tissue necrosis is due to direct injury, compression, or occlusion of the vasculature in the injection site by the filler material (i.e., HA), which in turn limits vascular supply, leading to ischemia and tissue necrosis. 10 In the case of our patient, it is possible that either the injection of HA into the incorrect anatomic site or the escape of HA from inside the joint due to vessel rupturing by direct injury or endothelial activation caused the occlusion of the deep veins.…”

“…10 In the case of our patient, it is possible that either the injection of HA into the incorrect anatomic site or the escape of HA from inside the joint due to vessel rupturing by direct injury or endothelial activation caused the occlusion of the deep veins. 11 Although many cases of cutaneous necrosis are associated with intra-arterial injections, the presence of HA in the vein causing necrosis has also been reported. 12,13 It is also worth noting that similar iatrogenic reactions have been described with accidental injections of medications such as vitamin K, NSAIDs, and glucocorticoids; these reactions are termed Nicolau syndrome and most likely share the same pathophysiology with those seen in HA.…”

“…There has been one case report of skin necrosis following IA HA injection, but cases of tissue necrosis in the glabellar or alar region of the face following HA filler injection for cosmetic purposes are well documented. 1,9…”

Dermal embolization associated with peroneal mononeuropathy: an unusual complication after hyaluronic acid intra‐articular injections

“…Skin biopsy demonstrated HA embolism in dermal vessels as the etiological factor. Only two similar cases are available in the literature, 4,5 but this is the first patient with associated neuropathy. It is reasonable to admit that neural damage is related to the involvement of vasa nervorum by HA embolism, similar to that demonstrated in skin vessels.…”

“…Some serious problems, including severe acute inflammatory reactions, infections, allergic reactions, and anaphylaxis, have been reported 2,3 . Skin necrosis is an extremely unusual complication, described in only two patients 4,5 …”