key: cord-0734099-jxbiykcx authors: Munavalli, Girish Gilly; Knutsen-Larson, Siri; Lupo, Mary P.; Geronemus, Roy G. title: Oral Angiotensin Converting Enzyme Inhibitors for the Treatment of Delayed Inflammatory Reaction of Dermal Hyaluronic Acid Fillers Following COVID-19 Vaccination – A Model for Inhibition of Angiotensin II-Induced Cutaneous Inflammation date: 2021-03-02 journal: JAAD Case Rep DOI: 10.1016/j.jdcr.2021.02.018 sha: 73fa8d653a3ec2318a03562bb3922a626541cbfc doc_id: 734099 cord_uid: jxbiykcx nan We present four cases of delayed inflammatory reaction (DIR) to facial dermal hyaluronic acid 33 (HA) filler rapidly following vaccination for COVID-19. All cases occurred with HA filler that 34 was placed more than one year prior to vaccination. All cases responded rapidly to low dose oral 35 angiotensin converting enzyme inhibitor (ACE-I) therapy, which decreases the cutaneous, filler-36 related inflammatory reaction and edema via a novel proposed mechanism. 37 Case Series 38 43-year-old woman with prior medical history significant for idiopathic urticaria, well-controlled 40 on daily Cetirizine 10mg. Patient has NKDA and no history of angioedema, and no prior history 41 of inflammatory filler reaction. Approximately two years prior to vaccination, she had one 42 syringe Restylane Lyft (Galderma, Upsala, Sweden) injected into her temples and one syringe 43 of Juvéderm Voluma  (Allergan, Irvine, CA) to lateral cheeks. The first dose of the Pfizer 44 BNT162b2 vaccine (Pfizer, New York, NY) was well tolerated, aside from two days of mild 45 injection site pain. Two days after the second dose of the Pfizer vaccine (given three weeks 46 apart), moderate swelling was noted in the periorbital area which extended to the involve the 47 malar on and medial cheeks. On the evening of the third day, the patient took Lisinopril 5 mg. 48 J o u r n a l P r e -p r o o f By morning of the next day, she was markedly improved. She was back to baseline by the 49 following day, but continued ACE-I therapy for two days afterwards without incident ( Figure 1a AngII can stimulate inflammation in this peri-granuloma milieu, inciting a CD8+, TH1 immune 142 response (Fig 4 ) which results in the clinical findings seen with DIR (11). This Agreement between DLVSC --Girish Munavalli ("You") and Springer Nature ("Springer Nature") consists of your license details and the terms and conditions provided by Springer Nature and Copyright Clearance Center. All payments must be made in full to CCC. 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The role of 211 the renin-angiotensin system in skin physiology and pathophysiology Human skin: 214 source of and target organ for angiotensin II The dual impact of ACE2 in COVID-19 and ironical 217 actions in geriatrics and pediatrics with possible therapeutic solutions Molecular interaction and inhibition of 220 SARS-CoV-2 binding to the ACE2 receptor ACE2: The key Molecule for Understanding the Pathophysiology of 222 Severe and Critical Conditions of COVID-19: Demon or Angel Angiotensin converting enzyme-2 as 225 therapeutic target in COVID-19 Multiple functions of angiotensin-converting enzyme 2 228 and its relevance in cardiovascular diseases Critical role of the 231 endogenous renin-angiotensin system in maintaining self-renewal and regeneration 232 9 Appendix 1 -Acknowledgements: For Journal Content: Reprinted by permission from [the Licensor] Author(s) Name), [COPYRIGHT] (year of publication), advance online publication Author(s) Name), [COPYRIGHT] (year of publication) Note: For any republication from the Author(s) Name) For Advance Online Publication papers: Reprinted by permission from The [the Licensor]: on behalf of Cancer Research UK J o u r n a l P r e -p r o o f This agreement sets out the terms and conditions of the licence (the Licence) between you and Springer Nature Customer Service Centre GmbH (the Licensor). 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