Effective Management of Late Inflammatory Nodules Following Hyaluronic Acid Fillers: A Case Series Treated With Methotrexate

With the rising popularity of hyaluronic acid (HA) fillers for cosmetic purposes, complications such as delayed-onset edema and nodules have become more frequent. These adverse reactions may be challenging to treat and often require multiple therapeutic strategies. We report 3 cases of women who developed late-onset edema and firm nodules following HA filler procedures. Conventional treatments, including corticosteroids, antibiotics, and hyaluronidase, were insufficient. Oral methotrexate at 15 mg per week was introduced, resulting in complete resolution in all cases within approximately 30 days. Low-dose methotrexate proved to be effective in managing persistent nodules and edema secondary to HA fillers. Methotrexate may represent a promising treatment option for delayed inflammatory responses following HA filler injections. Further prospective studies are needed to validate its safety and efficacy in this context.