The common side effects of vaccines are familiar to dermatologists. Generally, patients can expect mild edema and erythema at the injection site.1 Based on the phase 3 clinical trial data, three SARS-CoV-2 vaccines have been typical with localized redness and swelling.2 However, recent reports in the media have highlighted a serious adverse event (AE) of these novel vaccines: facial swelling in patients who have received dermal fillers.
According to FDA data for the Moderna mRNA-1273 vaccine, two patients experienced facial swelling and one experienced lip angio- edema within 2 days of receiving a dose of the mRNA vaccine.3 Of the patients with facial swelling, one (woman, aged 51 years) had dermal filler placed approximately 2 weeks’ prior to receiving a vaccine dose, and the other (woman, aged 46 years) had placement 6 months prior. In the case of lip angioedema, this particular patient (woman, aged 29 years) had previous medical history positive for lip angioedema after vaccination against influenza. All three cases of facial swelling following vaccination resolved.
Notably, these were three AEs out of 15,184 vaccine recipients, or an incidence rate of 0.02%. There is no current knowledge whether similar reactions occurred following administration of the FDA-approved BNT162b2 vaccine or any additional vaccines under trial, including AZD1222 and JNJ-78436735.4,5
In response, the American Society for Dermatologic Surgery (ASDS) issued a guidance statement to put these three cases in perspective.3 Chiefly, ASDS emphasized the rarity of delayed inflammatory events following dermal filler procedures. Based on evidence of these delayed AEs, which have been reported to occur after ill- ness, vaccination, or dental procedures, ASDS recommended that patients who have been treated with dermal fillers or who are planning to receive fillers in the future should not be discouraged or precluded from receiving any vaccines. In addition, dermatologists should continue their current practices regarding dermal fillers.
Answering Patient Questions
“Many patients are asking about the vaccine and dermal fillers, having heard media reports,” said Dr Derek Jones, director of Skin Care and Laser Physicians of Beverly Hills. He also serves as chair of the Soft Tissue Fillers Guideline Task Force of ASDS. He is not alone—cosmetic dermatologists and aesthetics professionals across the country are seeing an uptick in questions from patients regarding the safety of vaccines.
“I tell them that cosmetic dermatologists are accustomed to seeing cases of delayed swelling or nodule formation in areas of prior filler placement that may be associated with viral or bacterial illness, or dental procedures,” explained Dr Jones. “These are very rare and treatable. Such cases occur in a fraction of 1% of patients in our studies.”
Dr Jones advises his patients that there is no reason not to get the vaccine if they have dermal fillers or are planning to receive them. “If they develop a reaction, which would be unlikely, I ask them to call me immediately. These events are usually easily treatable and resolve.”
References
1. Vaccine side effects. US Department Health and Human Services. Updated February 2020. Accessed January 29, 2021. https://www.vaccines.gov/basics/safety/side_effects
2. Rice SM, Ferree SD, Mesinkovska NA, Kourosh AS. The art of prevention: COVID-19 vaccine preparedness for the dermatologist. Int J Womens Dermatol. Published online January 12, 2021. doi:10.1016/j.ijwd.2021.01.007
3. Avram M, Bertucci V, Cox SE, Jones D, Mariwalla K. Guidance Regarding SARS-CoV-2 mRNA Vaccine Side Effects in Dermal Filler Patients. American Society for Dermatologic Surgery; December 28, 2020. Accessed January 15, 2021. https://www.asds.net/Portals/0/PDF/ secure/ASDS-SARS-CoV-2-Vaccine-Guidance.pdf
4. Ramasamy MN, Minassian AM, Ewer KJ, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet. 2020;396(10267):1979-1993. doi:10.1016/S0140-6736(20)32466-1
5. Janssen investigational COVID-19 vaccine: interim analysis of phase 3 clinical data released. News release. National Institute of Allergy and Infectious Diseases. Published January 29, 2021. Accessed February 1, 2021. https://www.nih.gov/news-events/news-releases/ janssen-investigational-covid-19-vaccine-interim-analysis-phase-3-clinical-data-released
