There are an endless number of questions on the topic of treating clients with beauty or aesthetic treatments after COVID-19 infection and vaccines, from how long post-jab we need to wait before treatment, to how the immune response affects the skin, and how this might interfere with our treatments and procedures.
In the context of clinical research and how long it takes to collect sufficient data, this is an extremely new area. Not only have ABIC gathered all the latest evidence on this topic, but we’ve also put together a comprehensive list of considerations you (as a beauty, dermal or aesthetic practitioner) should keep in mind when approaching patients post-vaccine - particularly since many of the Australian population will be due for their 6-month booster shots very soon.
How the body responds to the vaccine
To understand this completely, we must first understand exactly how vaccinations work alongside our immune system. When a virus enters the body, it attaches itself to a cell and injects its own DNA or RNA into that cell. This acts like a set of instructions for the cell’s ribosomes that will direct them to create more of the virus. This will then leave that cell, spread, and carry out the same process on other cells - this is how the virus spreads throughout the body.
Our body’s innate immune response works to protect us from these types of invasions by learning how to combat the virus. Macrophages who encounter a virus will ingest it, break it down, and display a fragment of it (antigen) on its surface, which acts as a flag to notify other immune cells (B and T cells) that there has been an invasion, and that antibodies are required in order to combat it. However, this process can take days, and all the while, the virus continues to spread throughout the body by the minute. That’s where vaccines come in, proactively teaching our immune cells about the virus in order to create antibodies that work against that particular virus - before the infection occurs.
Some vaccines contain parts of the real virus itself, either a weakened form of it or inactive components like their proteins (this includes Astrazeneca). Other vaccines use the mRNA technique (including Pfizer and Moderna) and do not contain any of the virus itself, only some of its genetic code, in order to introduce it to the body and allow your immune cells to develop antibodies to combat it. COVID mRNA vaccines contain mRNA for only the spike protein component of the virus - the spiky branches that allow the virus to latch onto other cells and infect them. Therefore, the body is taught to recognise the spike protein as the intruder, COVID-19, and attack these spike proteins immediately if and when you become infected. This means the virus is unable to spread very far.
The COVID-19 virus is known for its ability to spread very rapidly. It predominantly latches to, and infects, cells of the airways and lungs - which is why lung capacity and shortness of breath is the most significant symptom and cause of concern. The infection causes a substantial amount of inflammation, which in the lungs results in fluid, mucus, and cough. Air sacs in the lungs are also destroyed or damaged, and can become scarred or stiffened, preventing the flow of oxygen.
Let’s consider how this process may affect the rest of the body, and of course the skin - what most of us are dealing with as practitioners.
Inflammation is heightened, which we know can cause oxidative stress.
Oxygen distribution is disrupted, affecting cell performance, ATP production, and our circulatory and lymphatic systems.
Immune activity is heightened. Our clients will have varying levels of immune capabilities, but an overactive immune system can lead to heightened reactivity or sensitisation.
This may be why we are hearing of so many anecdotal cases of unusual responses to treatment, such as allergy-type responses to products, periods of erythema and/or edema that are more significant than your patients’ typical endpoint, delayed skin healing, or general sensitisation or conditions such as dermatitis.
What does the research say?
Evidence to support these claims is beginning to surface. Below, we’ve detailed a handful of excerpts from peer-reviewed journals on skin manifestations relating to COVID-19.
Inflammation and Vascular Injury as the Basis of COVID-19 Skin Changes: Preliminary Analysis of 23 Patients from the Literature
“We performed literature search on Pubmed with terms skin rash and COVID-19 on September 20, 2020. Severity of novel coronavirus pneumonia was classified as mild, severe, and acute respiratory distress.5,6 Seven reports were found and most of these were case reports. Individual patient data extraction from searched literature mainly included demographic data, comorbidity, rash type, rash onset, and severity of COVID-19. Microvascular and endothelial cell injury, perivascular lymphocytic infiltrate, thrombosis, extremely dilated vessels and prominent deposits of C5b-9 were the main dermatologic pathological changes of COVID-19 patients.”
Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes
"Erythematous rashes represent the most frequent cutaneous manifestation in patients with COVID-19 and typically occur concurrently, or after the onset of COVID-19 symptoms.1,2 In this group, the maculo-papular pattern is the most common, followed by the macular and papulo-squamous one.1,3–8 In addition, other sub-patterns resembling pityriasis rosea, Grover disease and Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) have been described in some case reports. Several hypotheses exist to explain the pathogenetic mechanism of these cutaneous manifestations.11 In some cases, skin biopsy is consistent with an adverse reaction to drugs taken during infection.3 In particular, Rosell-Dìaz et al described a series of 12 patients with an itching papular exanthema and eosinophilia, suggesting a potential role of SARS-CoV-2 infection in inducing drugs hypersensitivity."
Skin and gastrointestinal symptoms in COVID-19
"Eight patients of the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw were reported to present dermal lesions associated with SARS-CoV-2 infection. The lesions included: erythematous macular lesions (2 patients – 25%), erythematous infiltrated lesions (2; 25%), erythematous infiltrated and exfoliative lesions (3; 37.5%), erythematous papular lesions (3; 37.5%), and erythematous oedematous lesions (2; 25%). What is remarkable, all of those patients reported gastrointestinal symptoms during the hospitalisation. Additionally, in 4 of them, the clinical picture and the histopathological results of derma lesion examination indicated that dermatoses and the gastrointestinal problems seem to be a drug-related reaction following the treatment of COVID-19.
The TGA COVID-19 vaccine weekly safety report dated 19th August 2021, referred to information regarding the findings of the European Medicines Agency’s Pharmacovigilance Risk Assessment Committee. The EMA considered that "there is a reasonable possibility that facial swelling could be caused by the Comirnaty (Pfizer) vaccine. These types of reactions can be triggered by the immune system after a viral or bacterial illness, vaccinations such as the influenza vaccine and dental procedures. Symptoms respond to treatments, such as oral corticosteroids and hyaluronidase, but often resolve on their own. These are extremely rare and temporary side effects. Given the protective benefits of vaccination outweigh the very small risk of these reactions, people who have previously received injectable dermal fillers should not be discouraged from getting vaccinated. Similarly, there is no need to avoid dermal fillers in the future for those who are already vaccinated."
How should we proceed as practitioners?
Based on the peer-reviewed evidence as well as anecdotal reports from industry, here are our recommendations on how to incorporate these considerations into your practice.
Reduce the inflammation. Primarily, the evidence points to an overactive immune system, which can cause allergy-type responses, extended periods of inflammation, poor healing abilities, as well as poor mitochondrial function. LED and Low-Level-Laser are particularly viable in this area. Use of highly-stimulating or thermal treatments may need to be avoided in patients who have suffered acute or extended adverse response to COVID-19 infection or vaccination. In these cases, consider approaching these clients with the types of treatments you would normally recommend for barrier-impairment, rosacea, or any other kind of inflammatory condition: soothing, calming, hydrating, anti-inflammatory, strengthening, and low incidence of irritancy.
Combat oxidative stress. Inflammation leads to reactive oxygen species, leading to oxidative stress. Recommend antioxidants not only topically but dietary antioxidants if you operate in this scope of practice.
Treat clients case-by-case. Immune system capabilities vary so much that perhaps a blanket rule is unwise. Ie. instead of suggesting ‘wait two weeks after vaccination to treat’, consult with your clients about their response to their vaccine. If they had an extreme response, more than two weeks may be required for their hyperactive immune system to regulate itself, reducing the chances of adverse reaction to treatment.
This new facet of client care is just another of the many variables we have had to deal with as beauty and aesthetic practitioners since the pandemic arrived on our shores. However, as always, safe happy clients and amazing experiences have always been our top priorities, and this is no different.
In conclusion, thorough consultation and assessment is key when creating a treatment plan for our patients and clients. Reasonable caution is recommended, as is the inclusion of anti-inflammatory treatments and precautionary measures.
No doubt more information will come to light after more extensive research is performed, but until then we as an industry are nothing if not resilient, and we've proven we know how to adjust and adapt, and care for our clients.