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Hidradenitis suppurativa is a chronic, recurrent, inflammatory skin disease that affects hair follicles, typically developing after puberty. It is characterized by painful, deep-seated inflammatory lesions that appear in anatomical regions where apocrine glands are located, mainly in the axillar, inguinal, and anogenital areas. The pathogenesis of hidradenitis suppurativa is multifactorial, with follicular occlusion representing the initial stage of the disease and subsequently leading to the formation of neutrophilic abscesses and infiltration by various inflammatory cells. The treatment of hidradenitis suppurativa requires a multidisciplinary approach, involving dermatologists and dermatologic surgeons, as well as physicians of other medical specialties. The primary pharmacological treatments for hidradenitis suppurativa involve antibiotics and biologic disease-modifying drugs, which can be used either in monotherapy or in combination with surgical interventions. The following guidelines provide up-to-date information on the management of patients with hidradenitis suppurativa.

Atopic dermatitis is often accompanied by a lack of sleep efficiency, which may impact neurocognitive functions. This review assesses the association between sleep quality in atopic dermatitis patients and neurocognitive decline. Databases searched included PubMed, Scopus, and Web of Science from inception to 8 January 2024, adhering to PRISMA guidelines. Cross-sectional and longitudinal studies were included. Records were screened and assessed for eligibility, with 13 studies included in the final analysis. From an initial pool of 4,529 records, 13 studies involving 272,868 participants met the inclusion criteria. The review identified a consistent pattern of sleep disruption in individuals with atopic dermatitis, which was associated with various short-term neurocognitive challenges such as impaired focus, decreased sleep efficiency, and lower IQ. Limited evidence was found for potential long-term cognitive decline associated with chronic atopic dermatitis. Lower sleep quality in atopic dermatitis is associated with neurocognitive deficits. While immediate effects are evident, further research is needed to understand potential long-term consequences. Integrating sleep management into atopic dermatitis care is imperative.

Acne vulgaris is the most common dermatosis among adolescents, but it can also affect adults. Acne lesions located on the face cause discomfort and lead to impaired quality of life for many patients. Acne is a dermatological condition with multiple causes and clinical manifestations, as well as varying degrees of severity. Dermatological treatment alone does not always bring good therapeutic effects, and occasionally it may result in symptoms of skin irritation. Therefore, using appropriate dermocosmetics is crucial in managing the condition. Dermocosmetics play a potentially important role in minimizing the adverse effects of acne medications, providing a synergistic effect by addressing other acne-causing factors and/or enhancing the efficacy of other treatment modalities, and protecting the skin against the adverse impacts of the exposome. In cases of mild acne, dermocosmetics can be used in monotherapy as an alternative to acne medications or for maintenance therapy. It is also advisable to combine dermocosmetics with topical or systemic therapies to achieve a synergistic effect or to prevent and reduce drug-induced adverse reactions. Dermocosmetics have keratolytic and anti-inflammatory properties, regulate sebum production, and help maintain the balance of the skin’s natural microbiome.

Abstract Ultraviolet nail lamps are becoming increasingly popular, however, the safety of their use remains controversial. The following article directly responds to recently published literature data and aims to determine the viability of human keratinocytes irradiated by a UV nail-drying machine. Cells were exposed to 365–405 nm wavelength UV light emitted by a nail drying machine in two time variants: 4 and 20 min, with and without sunscreen cream SPF50 protection, and compared to the untreated control. Compared to the control, cell viability after irradiation for 4 min decreased insignificantly (p

Background: Skin is the largest organ in the human body. Some skin parameters like moisturization and sebum secretion play a vital role in the skin’s functioning. This study aims to assess the effects of topical chemical peels of different concentrations and pH, applied manually and with ultrasounds, on the level of hydration, erythema, pigmentation, and sebum secretion of the skin. Methods: The study involved 90 Caucasian females, aged 25 to 59, with dry, dehydrated skin, skin with erythema or pigmentation disorders. The patients were randomly divided into three equal groups. The subjects from Group A were applied 10% mandelic acid with 25% gluconolactone of pH 4.0 manually. In Group B, 40% mandelic acid of pH 1.5 was used. The subjects from Group C were applied 10% mandelic acid with 25% gluconolactone of pH 4.0 via sonophoresis. A series of six procedures in weekly intervals was performed. Skin functional parameters (skin hydration, erythema, and melanin indicators) were taken before the first procedure, after 14 days, 28 days, and 42 days. Results: In Group A, the level of moisturization of the skin increased statistically significantly (p = 0.0100) however, the sebum secretion and erythema did not change. In Group B, the level of moisturization improved statistically significantly, as well as erythema (p = 0.0001). Sebum secretion in the final measurement increased. The moisturization and erythema in Group C did not differ statistically significantly. On the other hand, the sebum secretion increased significantly. Conclusions: Very superficial chemical peels significantly alter selected skin parameters. AHAs and PHAs applied using the ultrasound method do not affect the level of hydration, erythema, or pigmentation of the skin.

Introduction: Tear-through deformities can be a detectable sign of facial aging. Over recent years, minimally invasive procedures such as hyaluronic acid filler injections have been shown to be effective in improving this area. Malar edema is the accumulation of fluid over the malar eminence persisting for 1 month or more. Given its nature, the management remains problematic. The most commonly reported treatment modality is injection with hyaluronidase. Objectives: To determine the safety and efficacy pf triamcinolone injection in the treatment of malar edema. Methods: A total of 15 female patients with malar edema, with a mean age of 43.77 years, were treated with triamcinolone injections. The volume injected was chosen by the investigator. Prior to the triamcinolone injection, all patients had been treated with hyaluronidase, which turned out to be ineffective in all cases. Patients were asked to note all adverse effects. Results: Satisfactory results were achieved after a single treatment session for 14 patients and after two treatments for one patient. Overall, injections with triamcinolone were well tolerated and no adverse reactions were reported. Conclusions: Injection with triamcinolone appears to be a safe and effective option for the management of malar edema following hyaluronic acid filler injection. Nevertheless, further research with larger patient groups is compulsory.

Dermocosmetics (active cosmetics, functional cosmetics, cosmeceuticals) are preparations for external use, supporting pharmacotherapy of skin diseases during the active phase of the disease and in remission. They are also used for healthy skin (preventive) care. Historically, topical skin care products have been divided into cosmetics and drugs, as defined by the Federal Food, Drug and Cosmetic Act of 1938. A cosmetic was defined as ”articles intended to cleanse, care, beautify and improve the appearance of the skin”. Drugs were defined as ”products intended to affect the structure or any function of the body, or products intended for use in the diagnosis, treatment, mitigation, treatment or prevention of human diseases”. Dermocosmetics (cosmeceuticals) remain cosmetics from a legal point of view, but they fill the gap between cosmetics and drugs. These products achieve a cosmetic effect with active substances however are not subject to drug regulations.

Hyaluronic acid (HA), as one of the main components of the extracellular matrix (ECM), plays an important role in the process of wound-healing and tissue-repair processes due to its unique properties and different physiological functions. HA has an ability to maintain a moist environment that promotes healing, the stimulation of growth factors and cellular constituents, and the migration of various cells essential for healing. This paper offers a review of HA use in the process of wound healing, with emphasis on hard-to-heal wounds, and examines its various applications in ophthalmology and otorhinolaryngology. It proves HA to be a versatile agent which finds its use in various fields of medicine for its antioxidant, anti-inflammatory, antibacterial properties and accelerated wound healing.

ABSTRACT We characterized the population of Staphylococcus aureus from patients with atopic dermatitis (AD) in terms of (i) genetic diversity, (ii) presence and functionality of genes encoding important virulence factors: staphylococcal enterotoxins (sea, seb, sec, sed), toxic shock syndrome 1 toxin (tsst-1), and Panton-Valentine leukocidin (lukS/lukF-PV) by spa typing, PCR, drug resistance profile determination, and Western blot. We then subjected the studied population of S. aureus to photoinactivation based on a light-activated compound called rose bengal (RB) to verify photoinactivation as an approach to effectively kill toxin-producing S. aureus. We have obtained 43 different spa types that can be grouped into 12 clusters, indicating for the first-time clonal complex (CC) 7 as the most widespread. A total of 65% of the tested isolates had at least one gene encoding the tested virulence factor, but their distribution differed between the group of children and adults, and between patients with AD and the control group without atopy. We detected a 3.5% frequency of methicillin-resistant strains (MRSA) and no other multidrug resistance. Despite genetic diversity and production of various toxins, all isolates tested were effectively photoinactivated (bacterial cell viability reduction ≥ 3 log10 units) under safe conditions for the human keratinocyte cell line, which indicates that photoinactivation can be a good option in skin decolonization. IMPORTANCE Staphylococcus aureus massively colonizes the skin of patients with atopic dermatitis (AD). It is worth noting that the frequency of detection of multidrug-resistant S. aureus (MRSA) in AD patients is higher than the healthy population, which makes treatment much more difficult. Information about the specific genetic background of S. aureus accompanying and/or causing exacerbations of AD is of great importance from the point of view of epidemiological investigations and the development of possible treatment options.

Hydroxyurea therapy is commonly used in the treatment of patients suffering from myeloproliferative diseases, such as polycythemia vera. It is supported by evidence that this type of therapy can generate mild skin lesions like leg ulcers, erythema, and hyperpigmentation. There are also some studies that show an increased risk of development of nonmelanoma skin cancers. We report a 56-year-old man with a 13-year history of polycythemia vera, treated chronically with hydroxyurea. In April 2020, the patient presented a skin lesion on the forehead, skin horn on the left forearm, and hyperkeratosis on the rims of both ears. In the patient’s history, in October 2019, complete excision of the skin lesion in the central area of the forehead was performed. After 4 months, a new skin lesion appeared at the same area of the forehead, which in May 2020 after resection in the histopathological examination was diagnosed as recurrence of squamous cell carcinoma. The aim of the case is to draw the clinicians’ attention to the increased risk of squamous cell carcinoma and basal cell carcinoma in patients treated with hydroxyurea. Increased vigilance would make it possible to recognize them earlier, and thus potentially reduce the undesirable effects associated with the delayed radical treatment of these skin cancers. Randomized clinical trials assessing the potential benefits of oral retinoids for chemoprevention of nonmelanoma skin cancers in the hydroxyurea-treated population should also be considered.

Angioedema is a non-inflammatory edema of the subcutaneous tissue and/or mucosal membranes. It commonly coexists with urticaria and is considered a deep form of urticaria. Less commonly, it occurs as an isolated disease in one of two basic forms: acquired angioedema and hereditary angioedema. Four types of acquired angioedema and seven types of hereditary angioedema were difinied. The treatment of angioedema depends on its form and etiological factors, with hereditary angioedema posing a most significant challenge.

The most common treatments in the field of aesthetic dermatology and broadly understood aesthetic medicine are those with the use of fillers. For many, hyaluronic acid injections are considered very safe and the effects predictable. Therefore, the widely recognised reversibility of the effects of hyaluronic acid fillers and the growing variety of approved applications and formulations of these products increase their popularity. There are also numerous undesirable effects and complications, especially due to the fact that these treatments are performed both by unauthorised persons and under inappropriate conditions. Complications may be related to: incorrect injection technique, lack of treatment asepsis, reaction of the body to the presence of a foreign body and anatomical changes. Depending on the time when complications occur after hyaluronic acid administration, following complications may be distinguished: immediately complications that occur immediately or up to 3–5 days after administration are and late complications that occur even after several weeks, months or even years. Non-vascular complications of hyaluronic acid administration are: nodules, granulomas, persistent swelling, Tyndall effect, infections and biofilm. The most dangerous are vascular complications after hyaluronic acid administration, such as: ischaemia/partial or complete necrosis, vision abnormalities and blindness. Early recognition of a complication largely prevents permanent defects. The use of hyaluronidase injections is considered management of choice in the treatment of complications of hyaluronic acid fillers and should be performed immediately after the procedure with the use of the filler. Therefore, it was necessary to develop a consensus on the principles of hyaluronidase administration for complications of hyaluronic acid filler procedures.

Porphyria cutanea tarda belongs to the group of porphyrias. Porphyria is a heme disorder caused by an acquired or congenital defect of hepatic enzymes. This consequently leads to the accumulation of porphyrins in various organs. In porphyria cutanea tarda, there is a deficiency of the enzyme uroporphyrinogen decarboxylase. The most frequent factor that leads to damage of this enzyme is drug- or alcohol-induced liver insufficiency. In porphyria cutanea tarda typical clinical manifestations include blisters, erosions, crusts, and milia, that arise predominantly in sun-exposed areas. Furthermore, the skin becomes atrophic, susceptible to injuries and scarring. In our patient, the skin chances were induced by estrogen treatment of endometriosis in combination with UV-exposure. In this case the diagnosisi was established early and significant clinical consequences could be avoided.

Carboxytherapy is a very popular method applied in aesthetic medicine. The procedure is used for the reduction of cellulite, atrophic scarring and stretch marks, treatment of localized adiposities, wrinkle correction and rejuvenation of the skin. It is claimed that carbon dioxide therapy is a very safe procedure with only a small number of complications. Pain, oedema and bruising of the injection area are often side effects of carboxytherapy. There are only a few reports of more serious complications such as subcutaneous emphysema or Mycobacterium infection. The following is the first case report of herpes-associated erythema multiforme caused by carboxytherapy. A 41-year-old woman consulted a dermatologist because of erythematous skin lesions with brightening in the central part of the macules which appeared three days after the carboxytherapy. In the anamnesis recurrent herpes labialis was noted.

Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacteria. Among seven different isoforms, only BoNT-A and BoNT-B are commercially used. Currently, botulinum toxin has been indicated by the U.S. Food and Drug Administration in several disorders, among others: chronic migraine, hyperhidrosis, urinary incontinence from detrusor overactivity, or cosmetics. However, there are numerous promising reports based on off-label BTX usage, indicating its potential effectiveness in other diseases, which remains unknown to many. Among them, dermatological conditions, such as rosacea, annal fissure, Raynaud phenomenon, hypertrophic scars and keloids, and also hidradenitis suppurativa, are currently being investigated. This article aims to provide a comprehensive update on the off-label use of botulinum toxin in dermatology, based on an analysis and summary of the published literature.

Atopic dermatitis (AD) patients are massively colonized with Staphylococcus aureus (S. aureus) in lesional and non-lesional skin. A skin infection may become systemic if left untreated. Of interest, the incidence of multi-drug resistant S. aureus (MRSA) in AD patients is higher as compared to a healthy population, which makes treatment even more challenging. Information on the specific genetic background of S. aureus accompanying and/or causing AD flares would be of great importance in terms of possible treatment option development. In this review, we summarized the data on the prevalence of S. aureus in general in AD skin, and the prevalence of specific clones that might be associated with flares of eczema. We put our special interest in the presence and role of staphylococcal enterotoxins as important virulence factors in the epidemiology of AD-derived S. aureus. Also, we summarize the present and potentially useful future anti-staphylococcal treatment.

Adverse drug reactions (ADRs) are unexpected reactions to a medication administered in a correct way at a standard dose. Drug-induced skin reactions account for 60–70% of all ADRs. The aim of the study is to determine the prevalence of antibiotic-related dermatological ADR in patients treated in the department of Dermatology, Venerology and Allergology of the University Clinical Center in Gdańsk, Poland, in the years 2004–2021. A retrospective analysis of patients’ medical files was conducted in order to identify cases of ADR connected with the use of antibiotics, yielding 84 cases. The most common group of antibiotics were β-lactam, causing ADR in 47 patients. β-lactam antibiotics in our study included amoxicillin, alone and combined with clavulanic acid, and cephalosporins, affecting 22, 18 and 7 patients, respectively. In conclusion, β-lactam antibiotics showed the highest prevalence among antibiotic-induced skin reactions. They accounted for 15% of cases of all dermatological drug reactions and 55% of those caused by antibiotics. Especially amoxicillin, prescribed as a single drug or in combination with clavulanic acid, was commonly the culprit. Due to its wide use in the hospital and outpatient clinic, these adverse reactions have to be kept in mind by both hospital staff and general practitioners.

Chronic wounds are a growing problem for both society and patients. They generate huge costs for treatment and reduce the quality of life of patients. The greatest challenge when treating a chronic wound is prolonged infection, which is commonly caused by biofilm. Biofilm makes bacteria resistant to individuals’ immune systems and conventional treatment. As a result, new treatment options, including nanomaterials, are being tested and implemented. Nanomaterials are particles with at least one dimension between 1 and 100 nM. Lipids, liposomes, cellulose, silica and metal can be carriers of nanomaterials. This review’s aim is to describe in detail the mode of action of those molecules that have been proven to have antimicrobial effects on biofilm and therefore help to eradicate bacteria from chronic wounds. Nanoparticles seem to be a promising treatment option for infection management, which is essential for the final stage of wound healing, which is complete wound closure.

One of the modern methods of treatment of wounds covered by a biofilm is bacteriophage therapy. Bacteriophages (phages) are viruses that infect bacteria. Phages have a very strong bactericidal effect and can replicate at the site of the infection. They spread in the biofilm, and have the capacity for enzymatic degradation of the polymeric matrix material. Phage therapy has a high level of security and efficacy against resistant bacteria. Results of clinical studies with probiotic bacteria have shown effectiveness similar to antiseptics. Probiotic bacteria or substances produced by these bacteria may be an effective means in the fight against Pseudomonas aeruginosa. An innovative method of fighting bacterial biofilm is also the use of metal nanoparticles (NPs). Preliminary studies have shown beneficial effects of NPs in reducing the biofilm layer. New therapies will rapidly and effectively treat chronic wounds and reduce the cost of care for chronic ulcers.

Antimicrobial peptides (AMPs) are natural components of the immune system of organisms from the prokaryotic and eukaryotic kingdoms. The human body is equipped with more than 100 antimicrobial peptides that are an integral part of innate immunity. The main AMP families in human skin are β-defensins and cathelicidins. They are produced in cells such as keratinocytes, sweat glands, neutrophils, monocytes, NK cells and mast cells. Their particular function is a broad spectrum of antibacterial as well as antifungal, antiviral and antiprotozoal activity. The ability to kill bacteria involves penetration and destruction of the cell membrane, as opposed to traditional antibiotics that act by binding to specific cell structure. The antimicrobial peptides are involved in the pathogenesis of various skin diseases, including atopic dermatitis, psoriasis, and rosacea. The lack of a specific molecular target in a bacterial cell minimizes the risk of resistance development; hence the AMPs have become the target of intensive research in the last two decades.

Henoch–Schönlein purpura is a disease that belongs to the group of vasculitides. The disease in children is usually mild, but if it occurs in adulthood it can bring many adverse consequences. In mild forms, the major manifestation is skin lesions. The disease may also affect the joints, kidneys, gastrointestinal tract and lungs. The aim of the study is to present the differences in the course and prognosis of Henoch–Schönlein purpura in children and adults, the diversity of aetiological factors of IgA-associated vasculitis as well as clinical implications and diseases concomitant with purpura. Typically, it is believed that viral and bacterial agents induce Henoch–Schönlein purpura. Vaccination is one of the stimuli which can cause IgA-associated vasculitides. The coexistence of Henoch–Schönlein purpura with neoplasms is another interesting issue. The appearance of purpura may indicate a metastasis or recurrence. In adults, the course of Henoch–Schönlein purpura is much more severe – up to 75% of adults who have developed it have gastrointestinal complications. Renal complications occur in up to 87% of adult patients. Pain in the hip joints in the course of Henoch–Schönlein purpura may be a manifestation of necrosis of the femoral head. There are also described cases of complete myocardial infarcts or only its clinical signs. Epididymitis and scrotal oedema are complications of boys and men who have developed purpura. The occurrence of Henoch–Schönlein purpura in males older than 50 is associated with a worse prognosis. Patients with recurrent vasculitis should be carefully evaluated for the presence of a neoplasm.

Staphylococcus aureus ( S. aureus ) is a Gram-positive bacterium capable of causing various diseases, from skin infections to life-threatening necrotizing pneumonia, bacteraemia, endocarditis and toxic shock syndrome. Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide and is a major cause of human morbidity and mortality. Healthcare-associated MRSA (HA-MRSA) infections occur in individuals with a compromised immune system and people with prior surgery. Community-associated MRSA (CA-MRSA) infections often occur in healthy individuals and are epidemic in some countries, which may suggest that those strains are more virulent and transmissible than HA-MRSA. According to the Center for Disease Control and Prevention, a case of MRSA infection is community acquired when it is diagnosed in an outpatient or within 48 hours of hospitalization if the patient lacks the following traditional risk factors for MRSA infection: receipt of hemodialysis, surgery, residence in a long-term care facility, or hospitalization during the previous year; the presence of an indwelling catheter or a percutaneous device at the time culture samples were obtained. Although progress has been made toward understanding emergence of CA-MRSA, virulence factors and treatment options, our knowledge remains incomplete. The recent occurrence of CA-MRSA in addition to the widespread problem of MRSA in hospitals has underlined the high urgency to find novel treatment options for drug-resistant S. aureus .

Wprowadzenie: Ziarniniak grzybiasty (mycosis fungoides – MF) to chłoniako niskiej złośliwości, wywodzący się z obwodowych komórek T,pierwotnie zajmujący skórę. Cel pracy: Przedstawienie trudności diagnostycznych i terapeutycznychw MF. Opis przypadku: Przedstawiono przypadek dotyczący 72-letniejpacjentki z MF, objętej opieką przez Klinikę od października 2007 dowrześnia 2009 roku. Zmiany skórne miały cechy melanoerytrodermii,a obraz histopatologiczny wycinków ze zmian nie upoważniał do rozpoznaniarozrostu złośliwego. Początkowo rozpoznawano osutkępolekową oraz actinic reticuloid. Rozpoznanie MF ustalono dopiero po19 miesiącach obserwacji. Na skórze chorej wystąpiły zmiany rumieniowo-naciekowe, które w badaniu histopatologicznym miały cechyMF. Dwa miesiące później chora zmarła, mimo leczenia cytostatycznegoi naświetlań szybkimi elektronami. Wnioski: Przedstawiony przypadek potwierdza trudności diagnostycznewynikające z podobieństwa wczesnych okresów chłoniaka dodermatoz o podłożu zapalnym. Wyjątkowo niepomyślny przebieg choroby– pacjentka zmarła po 2 latach od momentu ustalenia rozpoznania– uzmysławia także ograniczenia możliwości terapeutycznych,szczególnie w zaawansowanych stadiach MF.

Wprowadzenie: Dipeptydylowa aminopeptydaza IV, znana równieżjako antygen CD26, odgrywa istotną rolę w patogenezie pierwotnychskórnych chłoniaków T-komórkowych (ang. cutaneous T-cell lymphoma– CTCL). Obecnie uważa się, że utrata tego antygenu z powierzchnilimfocytów świadczy o rozwoju zespołu Sezary’ego lub o progresjiinnych typów CTCL. Cel pracy: Ocena przydatności utraty z powierzchni limfocytów Tantygenu CD26 jako markera diagnostycznego i prognostycznegow ch��oniakach skóry oraz w innych chorobach zapalnych, przebiegającychz erytrodermią. Materiał i metodyka: Określenie metodą cytometrii przepływowejimmunofenotypu krwi obwodowej 71 pacjentów z zespołemSezary’ego, innymi CTCL oraz zapalnymi dermatozami, które wymagałydiagnostyki różnicowej z CTCL. Przeprowadzono ponadtobadanie cytologiczne krwi obwodowej w celu wykrycia komórekLutznera/Sezary’ego. Wyniki: U pacjentów z zespołem Sezary’ego oraz u chorych będącychw wyższych stadiach zaawansowania CTCL potwierdzono obecnośćznacznego odsetka komórek o fenotypie CD4+/CD7–/CD26–, przyjednoczesnym względnie małym stosunku limfocytów T4 : T8. Wnioski: Badanie utraty antygenu CD26 metodą cytometrii przepływowejokazało się przydatne w diagnostyce różnicowej CTCL,szczególnie w przypadkach rozwijających się z erytrodermią. Metodapozwala na wczesne wykrycie klonu nowotworowego CD4+/CD7–/CD26– u chorych z zespołem Sezary’ego oraz w innych zaawansowanychCTCL. Utrata antygenu powierzchniowego CD26 w przebiegudermatoz zapalnych, przy jednoczesnym dużym odsetkukomórek Lutznera we krwi, może stanowić czynnik ryzyka rozwojutych chłoniaków w przyszłości. Wymaga to jednak dalszych obserwacjiklinicznych.

Abstract Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24 h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.