title: Risk of severe adverse reactions to an injectable filler based on a fixed combination of hydroxyethylmethacrylate and ethylmethacrylate with hyaluronic acid.
abstract: BACKGROUND
  Hydroxyethylmethacrylate and ethylmethacrylate in a fixed combination with hyaluronic acid has been used as an injectable filler for nearly a decade. Severe adverse reactions have been associated with this filler.
  
  
  OBJECTIVE
  To characterize the adverse reactions to this filler.
  
  
  METHODS
  Data from the Berlin registry for adverse reactions to injectable fillers were analyzed. The registry is a partially population-based registry with the aim of collecting adverse reactions to injectable fillers. Patients were interviewed based on a standardized questionnaire.
  
  
  RESULTS
  Thirty-four of 118 (28.8%) registered patients were treated with this filler. Of 95 treated areas, 87 responded with a reaction (91.6%). The most frequently observed adverse events were the development of nodules (n=85) in 87 affected areas, discoloration (n=39), erythema or inflammation (n=32), and swelling (n=24). Most nodular reactions were rated as severe. The mean time after the last treatment until appearance of an adverse reaction was 23.1+/-22.8 months.
  
  
  CONCLUSIONS
  Adverse reactions to this methacrylate filler are common. The mean latency period for these mostly severe rated reactions was nearly 2 years. Based on the frequency and severity of these reactions, the use of this filler does not seem to be advisable.
authors.affiliation: Division of Evidence Based Medicine, Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Rossner
authors.forename: Florian
authors.initials: F
authors.lastname: Rossner
authors.forename: Frank
authors.initials: F
authors.lastname: Bachmann
authors.forename: Luitgard
authors.initials: L
authors.lastname: Wiest
authors.forename: Berthold
authors.initials: B
authors.lastname: Rzany
mesh_terms: D000179:Acrylates / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects; D003357:Cosmetic Techniques; D005145:Face; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D020100:Hydrogels / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011102:Polyhydroxyethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D019736:Prostheses and Implants / Q000009:adverse effects*; D012042:Registries
chemical_list: D000179:Acrylates; D001672:Biocompatible Materials; C482306:Dermalive; D020100:Hydrogels; D011102:Polyhydroxyethyl Methacrylate; C047731:hydroxyethyl methacrylate-ethyl methacrylate; D006820:Hyaluronic Acid