Hybrid cooperative complexes of high- and low-molecular weight hyaluronic acid injections in a patient with a history of pulmonary sarcoidosis

Injectable soft tissue filler procedures are a popular choice for the rejuvenation of the aging face. Thermal cross-linking of high- and low-molecular weight Hyaluronic Acid (HA) yields stable cooperative hybrid HA complexes with higher resistance to enzymatic degradation without the need for chemical agents [1]. Such formulations, such as IBSA Pharmaceuticals' Profhilo, have proven effective and safe both in vitro and in a multitude of patients with differing underlying conditions [2]. Sarcoidosis is a multisystemic disease of unknown etiology characterized by the formation of immune granulomas in several organs, primarily in the lung and lymphatic system[3]. The skin is the second most common organ affected in sarcoidosis (25-30% of cases), either as local sarcoidal granuloma formation, or as reactive nonspecific inflammation [3]. Tattoos, scars and cutaneous filling procedures have been reported as a potential triggers, and cases have been published reporting granulomatous inflammation in association with almost any kind of filler commercially available [4,5].