Abstract

Objectives: To evaluate the efficacy of using the immunosuppressant methotrexate to treat Covid vaccine related delayed onset nodules in twenty-three patients with moderate facial disfigurement unresponsive to established treatment protocols, including intralesional steroids and hyaluronidase. Introduction: During the COVID-19 pandemic, dermal fillers made world headlines as it was reported that patients who had cosmetic fillers experienced side effects after receiving vaccines that utilised both viral vector and mRNA technology. Initially the Moderna mRNA‐1273 vaccine trial reported an incidence rate of facial swelling of 0.02% after receiving the vaccine, and later similar effects were noted from both the Astra Zeneca and the Pfizer/BioNTech COVID‐19 vaccine. These problems appeared globally and were initially treated with antihistamines, hyaluronidase and intralesional steroids. Materials / method: Methotrexate is a chemotherapy agent and immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. It is particularly used to reduce activity of the immune system when it mistakenly attacks parts of the body, such as skin and joints, causing illness. Methotrexate is used to treat rheumatoid arthritis, psoriatic arthritis, vasculitis, systemic sclerosis, and severe psoriasis. It initially needs to be closely monitored, requiring blood tests every two weeks until stable, and then every three months. Results: We identified a cohort of 23 international patients injected with dermal filler or collagen stimulators who presented with delayed onset nodules after receiving the Covid booster vaccine. Eighteen of these patients were from Ireland, three from the United Kingdom, one each from France. the United States and Dubai. All of the patients were unresponsive to established treatment protocols, including antihistamines, 5-fuorouracil (5-FU), 5-FU and lidocaine, and intralesional steroids Conclusion: All patients successfully responded to 10mgs of Methotrexate for a three-month period and all their nodules dissipated. One patient had to stop the treatment in week ten due to moderately severe anergia. The treatment protocol above was submitted and accepted by peer review at both the AIDA Dermatology Conference in Abu Dhabi (May 2022) and the IMCAS World Conference in Paris (June 2022). It has changed the lives of many patients by reducing the gross distress caused by this condition