Dupilumab Linked to Delayed Inflammatory Reactions at Previous HA Filler Sites

A newly published case report has linked the biologic dupilumab to recurrent delayed inflammatory reactions at previous hyaluronic acid filler injection sites, representing a new diagnostic consideration for injectors. The report, from researchers at Imam Mohammad Ibn Saud Islamic University, details a 34-year-old female patient who presented on September 3, 2024, with persistent bilateral malar nodules. One hour after receiving a 600mg loading dose of dupilumab, she experienced warmth, pain, and swelling at her prior filler sites, where she had previously received 1mL of lightly cross-linked, low-viscosity hyaluronic acid. These nodules progressed over 24 hours and recurred with subsequent 300mg doses of the biologic. The temporal association scored an 8 on the Naranjo Adverse Drug Reaction Probability Scale, indicating a probable drug-induced reaction. The swelling and nodules were successfully resolved using 150 units of hyaluronidase. For clinical practice, this association suggests we should screen patients for current or planned dupilumab therapy during filler consultations. If a patient on this biologic presents with unexplained, localized late-onset nodules, localized hyaluronidase remains the primary resolution path.

Source: Journal of Cosmetic Dermatology, https://doi.org/10.1111/jocd.70997