Recognition and treatment of non-infectious hyaluronic acid reactions.

To differentiate a non-infectious inflammatory reaction following hyaluronic acid injection for facial rejuvenation from other reported complications, and describe appropriate treatment. Using a review of the literature and information available from the manufacturer, recommendations for management of non-infectious hyaluronic acid reactions are made. Patients who are afebrile with a normal white blood cell count and negative cultures, who appear to have an infectious process following hyaluronic acid injection are in fact having an inflammatory response. The inflammation may worsen with antibiotic therapy. Treatment should be systemic and/or local steroids, which may need to be for up to 6 months. After reviewing the literature, non-infectious inflammatory reaction following hyaluronic acid injection is exceedingly rare with only one other reported case. Erythematous skin in the week following injection without other infectious markers, such as fever or elevated serum white blood cell count, is an inflammatory reaction and should be treated with steroid therapy.