PDF BG (Български)


dermal fillers, intra-articular manipulations, complications

How to Cite

Dimova, Z., Boyadzhieva, V., Stoilov, N., & Stoilov, R. (2022). MANAGEMENT OF COMPLICATIONS FROM DERMAL FILERS AND INTRAARTICULAR MANIPULATIONS: RARE OR NOT SO RARE?. Rheumatology (Bulgaria), 30(1), 66-77.


With the development of Dermatology, the popularity of dermal fillers and the interest in them inevitably increases. More and more, patients are seeking their own dermatologist for cosmetic correction. The increase in the number of procedures performed leads to an increase in the frequency of their complications, which is one of the main reasons why these patients seek consultation with a rheumatologist.

Intra- and periarticular administration of corticosteroids is an important part of rheumatological practice in the treatment of various inflammatory joint diseases. This in turn carries risks of side effects that may be related to the systemic or local action of the corticosteroid.

We present two cases from the clinical practice related to complications after injecting hyaluronic acid and corticosteroid. The first case is of a woman in whom an aesthetic correction was made to rejuvenate the hands by placing hyaluronic acid in the dorsal part of the hands. The patient complained of redness, warmth, shine, swelling and burning pain in the area of ​​manipulation. The second case is of a patient with Juvenile Idiopathic Arthritis with bilateral carpitis who has been injected with intra-articular corticosteroids repeatedly (more than 20 for a period of 18 years). After the last intra-articular administration of corticosteroid in the radiocarpal joint, it was observed hypopigmentation and skin atrophy in the area of ​​the procedure.
PDF BG (Български)


  1. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol. 2013 Dec 12;6:295-316.
  2. Rzany B, Hilton S, Prager W, et al. Expert guideline on the use of porcine collagen in aesthetic medicine. J Dtsch Dermatol Ges. 2010;8(3):210–217.
  3. Rivkin AZ. Volume correction in the aging hand: role of dermal fillers. Clin Cosmet Investig Dermatol. 2016 Aug 30;9:225-32.
  4. Lefebvre-Vilardebo M, Trevidic P, Moradi A, Busso M, Sutton AB, Bucay VW. Hand: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(Suppl 5):258S–275S.
  5. Goldberg DJ. Legal ramifications of off-label filler use. Dermatol Ther. 2006;19(3):189–193.
  6. Cunnington J, Marshall N et al. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum. 2010 Jul;62(7):1862-9.
  7. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines.Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum 2002; 46:328–46.
  8. Cunnington J, Platt P, Raftery G et al. Attitudes of United Kingdom rheumatologists to musculoskeletal ultrasound practice and training. Ann Rheum Dis 2007; 66: 1381– 3.
  9. Jones A, Regan M, Ledingham J et al. Importance of placement of intra-articular steroid injections. BMJ 1993; 307: 1329– 30.
  10. Jackson DW, Evans NA, Thomas BM. Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am 2002; 84-A: 1522– 7.
  11. Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy 2005; 21: 77– 80.
  12. Raza K, Lee CY, Pilling D et al. Ultrasound guidance allows accurate needle placement and aspiration from small joints in patients with early inflammatory arthritis. Rheumatology (Oxford) 2003; 42: 976– 9.
  13. Balint PV, Kane D, Hunter J Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J Rheumatol 2002; 29: 2209– 13.
  14. Cheng J, Abdi S. COMPLICATIONS OF JOINT, TENDON, AND MUSCLE INJECTIONS. Tech Reg Anesth Pain Manag. 2007 Jul;11(3):141-147.
  15. Sundaram H, Cassuto D. Biophysical characteristics of hyaluronic acid soft-tissue fillers and their relevance to aesthetic applications. Plast Reconstr Surg. 2013;132(4 Suppl 2):5S–21S.
  16. Vedamurthy M. Beware What You Inject: Complications of Injectables-Dermal Fillers. J Cutan Aesthet Surg. 2018 Apr-Jun;11(2):60-66
  17. Urdiales-Gálvez F, Delgado NE et al. Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations. Aesthetic Plast Surg. 2018 Apr;42(2):498-510.
  18. DeLorenzi C. Complications of injectable fillers, part 2: vascular complications. Aesthet Surg J. 2014 May 1;34(4):584-600
  19. King M. Management of Edema. J Clin Aesthet Dermatol. 2017 Jan;10(1):E1-E4.
  20. Bellamy, N, Campbell, J, Robinson et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005328.
  21. Dent PB, Walker N. Intra-articular corticosteroids in the treatment of juvenile rheumatoid arthritis. Curr Opin Rheumatol. 1998 Sep;10(5):475-80.
  22. Godwin, M, Dawes, M. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Can Fam Physician. 2004;50:241–248.
  23. Stout A, Friedly J, Standaert CJ. Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. PM R. 2019 Apr;11(4):409-419
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.