Herpes Virus Outbreaks After Dermal Hyaluronic Acid Filler Injections

Abstract

Herpes virus outbreak after dermal filler injection is a rare but troublesome complication, caused by virus reactivation. Herpes simplex virus 1 (HSV-1) is often involved (according to data released by the FDA, the incidence does not exceed 1.45% of cases), whereas herpes zoster (HSZ) onsets are more rare.1 Many adverse effects after facial filler injections have been widely described and discussed by several authors,2,3 but the literature is scant regarding HSV and HZV reactivations after hyaluronic acid filler injections. The family of herpesviridae includes HSV-1, herpes simplex virus 2 (HSV-2), herpes zoster virus, Epstein-Barr virus, cytomegalovirus, human herpes virus 6, human herpes virus 7, and human herpes virus 8. Clinical reactivations after dermal filler injections have been described for herpes simplex and herpes zoster viruses. These viral agents have in common the double-stranded linear DNA that replicates inside the nucleus and their capability for latent and persistent infection. Herpes simplex viruses are characterized by mucocutaneous infections, although systemic infections have been rarely described. HSV-1 is classically associated with labial infections and cranial localizations, whereas HSV-2 consists of the etiologic agent of herpes simplex genitalis. Recently, it has been shown that in some populations, HSV-1 is the most frequent cause of herpes genitalis.4 The varicella zoster virus occurs both in children (primary infection, chicken pox) and adults (secondary infection, herpes zoster). The virus penetrates through the respiratory …