Hypochlorous Acid for a Persistent Filler Nodule: A Case Report

While noninflammatory nodules after hyaluronic acid (HA) filler injection are a relatively common phenomenon, delayed-onset nodules (DONs) are relatively uncommon and a significant complication of HA filler treatment. DONs can be inflammatory, granulomatous, or infectious. Infectious nodules are a significant concern for aesthetic providers due to the development of biofilms, and understanding the pathophysiology, diagnosis, and management of DONs is essential for clinicians to minimize risks and optimize patient outcomes. A sixty-year-old female presented to the clinic with a 3 cm hard, rope-like, indurated nodule with finger-like projections and purulent exudate on the left zygomatic cheek. She developed a firm, growing nodule, which was treated with hyaluronidase, intralesional fluorouracil, steroids, and antibiotics over multiple visits at an outside clinic. Steroid treatment resulted in attenuation of growth, but the nodule grew subsequently afterward. At our office, we added hypochlorous acid to the treatment plan over 3 clinic visits, resulting in the lesion decreasing in size significantly with no tenderness, swelling, or drainage. Biofilms are a therapeutic challenge because of their antibiotic resistance, unique biochemical milieu, and ability to evade the immune system. Hypochlorous acid is a safe and effective treatment for infections because of its broad-spectrum antimicrobial coverage and oxidative properties.