Hyaluronic-acid

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Hyaluronic-acid Vascular occlusion of the supratrochlear artery and alopecia: case report A 30-year-old woman developed vascular occlusion of the supratrochlear artery and alopecia during treatment with hyaluronic acid as a filler for ptosis of the right eyelid. The woman, who had frown lines, crow’s feet and horizontal forehead lines, received treatment with botulinum toxin-A injection. A week following the procedure, ptosis of the right eyelid appeared. To correct this, she was administered hyaluronic acid injection [dosage not stated] along the superciliary arch with no apparent complications. Forty-eight hours afterwards, she developed patchy erythema, swelling of the forehead and severe pain. A suspicion of soft tissue infection was made, and the woman was administered clavulanic acid and amoxicillin. She achieved a partial clinical response; however, one week later, she developed a rapidly spreading patch of alopecia on her right frontoparietal region of the scalp. At the periphery of the patch, hair pull test was found to be positive, and her skin was erythematous. She was administered triamcinolone on two occasions; however, the alopecia patch continued to expand. Trichoscopic findings revealed a patch of noncicatricial alopecia with multiple black dots, yellow dots, broken hairs and an irregular vascular proliferation made up of pigment deposits, ectatic vessels and background erythema. On the basis of her clinical history, the trichoscopic findings and physical examination showing an erythematous linear tract along her forehead, a suspicion of vascular occlusion of the supratrochlear artery secondary to hyaluronic acid was made. She underwent a punch biopsy, and throughout the patch, hyaluronidase were administered, followed by aspirin [acetylsalicylic acid]. No visual alterations were reported. The scalp biopsy showed a reduction in the density of dilated capillaries, anagen-phase hair follicles, and a moderate perifollicular inflammatory cell infiltrate made up of histiocytes and lymphocytes. Concentric thickening of the perifollicular collagen fibers was observed. A basophilic amorphous material in the dermis and within the vessels’ lumen inducing a granulomatous reaction was noted. This material was found to be positive for colloidal iron and alcian blue stains, showing that the substance was compatible with hyaluronic acid. One week following the hyaluronidase injection, her alopecic patch stabilised and stopped spreading; erythema, pain and swelling also decreased. She was commenced on minoxidil. Upon follow-up 2 months afterwards, she had a hair regrowth, and the trichoscopic findings, erythema and swelling disappeared. Author comment: "The present report is the first case describing the trichoscopic findings in [hyaluronic acid]induced alopecia." "Based on the clinical history, physical examination revealing an erythematous linear tract along the forehead and the trichoscopic findings, a vascular occlusion of the supratrochlear artery secondary to [hyaluronic acid] was suspected." Asz-Sigall D,

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