Aesthetic interventions in patients with allergic skin diseases: Risk assessment and evidence-based preventive risk management

 

Yiğit İK, Türsen Ü, Türsen B et al. Clin Dermatol. 2026 Mar 13:S0738-081X(26)00060-X. doi: 10.1016/j.clindermatol.2026.03.001. 

Abstract

The use of aesthetic dermatologic procedures in patients with underlying allergic and inflammatory skin diseases is on the rise, but specific safety considerations are often overlooked. Individuals with hypersensitivity to injectables, chronic inducible urticaria, allergic contact dermatitis, atopic dermatitis, or hereditary angioedema may face an increased risk of adverse reactions triggered by mechanical trauma, injected substances, or disruption of the skin barrier.

Adverse reactions to local anesthetics are predominantly non-IgE-mediated. Thus, preventive strategies should focus on selecting the appropriate agents and employing proper injection techniques rather than routine pharmacologic prophylaxis. Botulinum toxin, hyaluronic acid fillers, and hyaluronidase can rarely cause immediate or delayed hypersensitivity reactions. This highlights the need for individualized risk assessment and avoidance of reexposure in confirmed cases. For patients with chronic inducible urticaria, aesthetic procedures can act as physical triggers. Ensuring optimal disease control with preprocedural antihistamines may help reduce this risk. In cases of allergic contact dermatitis and atopic dermatitis, a compromised skin barrier and exposure to device-related allergens may heighten the chances of developing eczematous or infectious complications. Patients with hereditary angioedema require short-term prophylaxis, preferably utilizing C1-inhibitor therapy. With careful evaluation and tailored preventive strategies, aesthetic dermatologic procedures can be performed safely in patients with allergic and inflammatory skin conditions.

The demand for aesthetic dermatology procedures has rapidly increased, with a growing proportion of patients with chronic inflammatory or allergic skin diseases seeking cosmetic interventions.1 Dermatologists are increasingly encountering individuals with urticaria, dermatitis, drug hypersensitivity, or hereditary angioedema (HAE) who request treatments like injectables, microneedling, or energy-based therapies. Patients with allergic diseases may exhibit a heightened susceptibility to hypersensitivity reactions, exacerbation of their conditions, or trauma-induced edema during aesthetic procedures due to underlying immune dysregulation and impaired skin barrier function.

Disruption of the epidermal barrier is now recognized as a primary mechanism in the development of atopic sensitization and allergic diseases. When the skin barrier is compromised, environmental allergens and microbial antigens can more easily penetrate, leading to T helper 2-driven immune activation and subsequent sensitization. This barrier dysfunction is well established in atopic dermatitis (AD) and related allergic conditions, where it either precedes or amplifies immune dysregulation and the progression of atopic disease.2 Many aesthetic dermatologic procedures involve mechanical trauma, injections, or energy-based tissue injury, which may further disrupt the skin barrier and trigger inflammatory or allergic responses in susceptible individuals.

Despite the rising interest for cosmetic procedures in this patient demographic, there are limited safety data in aesthetic dermatology, and dermatologists often have to rely on extrapolated findings from the literature. In this discussion, we explore the risks associated with aesthetic procedures in patients with major allergic and inflammatory skin conditions and offer practical recommendations for preprocedural assessment and preventive management in aesthetic practices.

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