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de la Torre Gomar FJ, Gimeno Castillo J, Rosés Gibert P, Iglesias Martínez E, Martínez González MI. Silicone-induced granulomas successfully treated with adalimumab. J DERMATOL TREAT 2023; 34:2174786. [PMID: 36715364 DOI: 10.1080/09546634.2023.2174786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | | | - Pau Rosés Gibert
- Dermatology Department, Hospital Universitario Araba, Vitoria, Spain
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2
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Nguyen TV, Nguyen TT, Vo NQ, Hoang NT, Le TB, Le HP, Ngo DHA. Complicated breast augmentation via self-injection of ultrasound gel and shoe glue: A case report. Radiol Case Rep 2022; 18:794-798. [PMID: 36582757 PMCID: PMC9793175 DOI: 10.1016/j.radcr.2022.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Various types of dermal fillers have been developing for soft tissue augmentation. Even though many fillers have been approved and strictly regulated by authorities, homemade products for body contouring procedures are widely available and easily purchased on websites without prescriptions. It is challenging for radiologists to interpret radiological findings of complicated breast augmentation of unknown origin. While ultrasound is the modality of choice for initial work-up, magnetic resonance imaging (MRI) plays a role as the gold standard in evaluating the integrity of prosthetic implants. Using silicone or water-only MRI sequences may also be able to distinguish them. We report a rare case of breast abscess of a young female patient after self-injection of the mixture of ultrasound gel and shoe glue. The clinical and imaging aspect, especially MRI imaging, will be discussed.
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Affiliation(s)
- Thao Van Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen st., Hue city, Thua Thien Hue 530000, Vietnam
| | - Thanh Thao Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen st., Hue city, Thua Thien Hue 530000, Vietnam
| | - Nhu Quynh Vo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen st., Hue city, Thua Thien Hue 530000, Vietnam
| | - Ngoc Thanh Hoang
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen st., Hue city, Thua Thien Hue 530000, Vietnam
| | - Trong Binh Le
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen st., Hue city, Thua Thien Hue 530000, Vietnam
| | - Hong Phuc Le
- Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Dac Hong An Ngo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen st., Hue city, Thua Thien Hue 530000, Vietnam,Corresponding author.
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3
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The Benign Side of the Abdominal Wall: A Pictorial Review of Non-Neoplastic Diseases. Diagnostics (Basel) 2022; 12:diagnostics12123211. [PMID: 36553218 PMCID: PMC9778078 DOI: 10.3390/diagnostics12123211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The abdominal wall is the location of a wide spectrum of pathological conditions, from benign to malignant ones. Imaging is often recommended for the evaluation of known palpable abdominal masses. However, abdominal wall pathologies are often incidentally discovered and represent a clinical and diagnostic challenge. Knowledge of the possible etiologies and complications, combined with clinical history and laboratory findings, is crucial for the correct management of these conditions. Specific imaging clues can help the radiologist narrow the differential diagnosis and distinguish between malignant and benign processes. In this pictorial review, we will focus on the non-neoplastic benign masses and processes that can be encountered on the abdominal wall on cross-sectional imaging, with a particular focus on their management. Distinctive sonographic imaging clues, compared with computed tomography (CT) and magnetic resonance (MR) findings will be highlighted, together with clinical and practical tips for reaching the diagnosis and guiding patient management, to provide a complete diagnostic guide for the radiologist.
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4
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Silverberg OM, Cyrenne BM, Croitoru D, Sandre MK, Pon K. A case of recalcitrant silicone granuloma treated with adalimumab: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221093444. [PMID: 35573102 PMCID: PMC9102130 DOI: 10.1177/2050313x221093444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Liquid silicone is a relatively inexpensive injectable used for soft tissue augmentation. Injection of silicone is associated with a risk of delayed granuloma formation associated with elevated levels of tumour necrosis factor-α. We report a case of recalcitrant silicone granulomas following facial injections of silicone successfully treated with tumour necrosis factor-α blockade. Our case, as well as previous reports, demonstrates the effectiveness of this therapy for the treatment of foreign body granulomas from due to silicone.
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Affiliation(s)
- Orli M Silverberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit M Cyrenne
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew K Sandre
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kucy Pon
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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5
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6
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Liquid Silicone-Induced Extensive and Debilitating Granulomatosis Responding to Hydroxychloroquine. Case Rep Rheumatol 2019; 2019:8173790. [PMID: 31428505 PMCID: PMC6681618 DOI: 10.1155/2019/8173790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022] Open
Abstract
In the last two decades, there has been a significant rise in body-image improvement among the American consumers. Cosmetic injectable procedures have increased by 40.6% in the past 5 years. There has also been an increase in nonmedical, illegal, and self-appointed personnel, offering cheaper hazardous procedures. Silicone has been in use since 1965. In 1991, FDA issued guidelines prohibiting the marketing of injectable liquid silicone. However, it is biologically inert, is associated with inflammatory response, and leads to serious complications like granulomatosis, migration, acute pneumonitis, pulmonary embolism, and even death. Here, we present a case of silicone-induced granulomatosis with extensive migration which ended in bilateral mastectomy, multiple anterior chest debulking procedures, and finally peg tube placement due to compression of the esophageal lumen by granulomas. The patient was eventually started on immunomodulatory treatment, hydroxychloroquine with good response.
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7
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Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. J Am Acad Dermatol 2019; 80:1712-1721. [DOI: 10.1016/j.jaad.2018.05.1259] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/28/2022]
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8
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Abstract
BACKGROUND Transgender individuals experience common and unique dermatologic concerns from severe acne associated with testosterone therapy in transmen to complications due to illicit silicone injections in transwomen. Currently, 2 survey studies and 4 reviews have addressed the dermatologic care of transgender individuals. However, none of them provide a focus on the dermatologic surgeon. OBJECTIVE To assess the dermatologic considerations in transgender individuals and the role of dermatologic surgeon in their care. METHODS The PubMed and MEDLINE databases were reviewed in June 2018 using keywords, such as transgender, procedures, hair removal, laser, and hormone therapy. RESULTS In total, 48 relevant publications addressing dermatologic care in transgender patients were reviewed. According to the literature, there are several critical dermatologic considerations in transgender patients, including hair growth and removal, acne vulgaris, facial procedures to masculinize and feminize the face, scar removal, and sexually transmitted infections. CONCLUSION As dermatologic surgeons have the privilege to improve the health care of transgender patients, they must understand the common and unique concerns of transgender individuals. Given the considerable spectrum of physical goals expressed by transmen and transwomen, individual patient preference must ultimately guide his/her/their dermatologic care.
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Alijotas-Reig J, Esteve-Valverde E, Gil-Aliberas N, Garcia-Gimenez V. Autoimmune/inflammatory syndrome induced by adjuvants-ASIA-related to biomaterials: analysis of 45 cases and comprehensive review of the literature. Immunol Res 2019; 66:120-140. [PMID: 29199390 DOI: 10.1007/s12026-017-8980-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Systemic autoimmune or granulomatous disorders related to biomaterials of human use have rarely been described. The aim of this study was to report cases of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) related to biomaterial injections and prostheses, mainly silicone, hyaluronic acid, acrylamides and methacrylate compounds in a Spanish patient cohort. This study is a retrospective analysis of clinical, laboratory, histopathological and follow-up data of 45 cases of patients suffering from late-onset, non-infectious inflammatory/autoimmune disorders related to bioimplants. Late onset was defined as 3 months or more post injection. Data were obtained through a further non-systematic but comprehensive review of the literature. Forty-five cases of late-onset adverse reactions related to biomaterial injections or prostheses were reviewed. All cases had systemic complaints that could be categorised as ASIA. In all but four patients, inflammatory features at the implantation site preceded distant or systemic manifestations. Abnormal blood tests were common. Localised inflammatory nodules and panniculitis in 40/45 (88.88%) evolved into a variety of disorders, viz., primary biliary cirrhosis, Sjögren's syndrome, sarcoidosis, human adjuvant disease, vasculitis, inflammatory bowel syndrome and inflammatory polyradiculopathy. Five (11.11%) cases presented primarily with systemic autoimmune disorders. Biomaterials and prostheses can provoke late-onset systemic autoimmune disorders fulfilling ASIA criteria, or present primarily local/regional inflammatory reactions that may eventually evolve into systemic autoimmune and/or granulomatous disorders which fall under ASIA.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine-1, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Natalia Gil-Aliberas
- Department of Internal Medicine, Althaia Network Health, Manresa, Barcelona, Spain
| | - Victor Garcia-Gimenez
- Europe Medical Centre, Barcelona, Spain.,Spanish Society of Cosmetic Medicine & Surgery, Barcelona, Spain
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10
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Yedla N, Perez E, Lagari V, Ayala A. SILICONE GRANULOMATOUS INFLAMMATION RESULTING IN HYPERCALCEMIA: A REVIEW OF THE LITERATURE. AACE Clin Case Rep 2018; 5:e119-e123. [PMID: 31967015 DOI: 10.4158/accr-2018-0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective Silicone usage for cosmetic enhancement is common, although it is not approved by the U.S. Food and Drug Administration. Granulomatous inflammation leading to hypercalcemia is a rare complication. We present a case of non-parathyroid hormone (PTH), calcitriol-mediated hypercalcemia in a woman with a history of cosmetic injections. Methods Case report and review of the literature. Results A 48-year-old female with metabolic syndrome was evaluated for severe hypercalcemia (calcium >15 mg/dL). Laboratory tests revealed low-normal PTH, normal 25-hydroxyvitamin D, elevated 1,25-dihydroxyvitamin D, and hypercalciuria. Imaging studies, including a computed tomography (CT) scan of the lungs, was nonrevealing. Positron emission tomography/CT showed symmetric hypermetabolic subcutaneous stranding of bilateral gluteus and proximal thighs. She admitted to silicone injections in the buttocks 10 years prior. Her examination was unremarkable except for an intermittent pruritic rash over the right thigh. Labs revealed total serum calcium 11.3 mg/dL, PTH 18 pg/mL, 24-hour urinary calcium 509 mg, and PTH-related peptide 18 pg/mL. Serum and urine electrophoresis were normal, 25-hydroxyvitamin D was 47 pg/mL, and 1,25-dihydroxyvitamin D was 121 pg/mL. Angiotensin-converting enzyme level was 80 U/mL. A diagnosis of granulomatous inflammation resulting in calcitriol-mediated, PTH-independent hypercalcemia was entertained. Conclusion Silicone-induced hypercalcemia should be thought of in those with prior cosmetic injections. Tissue biopsy confirms the diagnosis, which is often delayed. We reviewed 19 cases with silicone usage and variable levels of hypercalcemia. Renal injury was common. One death was reported. Glucocorticoids, calcium restriction, and hydration have been used to treat calcitriol-mediated hypercalcemia but are not curative. Ketoconazole and bisphosphonates have been used with variable success. Surgical excision tends to be ineffective due to silicone migration. The treatment of this disorder is difficult and often ineffective.
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11
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Wang LL, Thomas WW, Friedman O. Granuloma formation secondary to silicone injection for soft-tissue augmentation in facial cosmetics: Mechanisms and literature review. EAR, NOSE & THROAT JOURNAL 2018; 97:E46-E51. [PMID: 29493732 DOI: 10.1177/0145561318097001-211] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The use of injectable fillers is increasingly popular as an alternative to surgery for facial cosmetic applications. In this regard, silicone is a versatile biomaterial filler that has been used for these purposes, but its use warrants further investigation, especially since it is not clinically approved for such uses. We describe the use of silicone as a facial injectable filler through a scholarly review of the literature for cases of silicone granuloma formation published from September 2007 through September 2017, and we present various contexts in which this complication has been observed. We further review the immunologic etiology of granuloma formation and other complications of silicone injections. We write this report to caution physicians on the use of silicone fillers which, for all their advantages, are associated with significant long-term risks that are frequently overlooked.
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Affiliation(s)
- Leo L Wang
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
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12
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Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain. Case Rep Med 2018; 2018:1802794. [PMID: 30073026 PMCID: PMC6057356 DOI: 10.1155/2018/1802794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/25/2018] [Indexed: 01/16/2023] Open
Abstract
Background Silicone injection is commonly used for soft tissue augmentation for esthetic purposes. It is not without complications. Case presentation We present a case of a 31-year-old woman presenting with refractory left lateral hip pain. Magnetic resonance imaging of the patient's pelvis revealed innumerable small low signal foci throughout the gluteus maximus and overlying subcutaneous fat bilaterally consistent with injectable material, possibly silicone. Conclusions This case report emphasizes that silicone-induced granulomatosis must be considered in the differential diagnosis of hip pain when evaluating a patient who has had access to plastic surgery or clandestine operators.
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13
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Abstract
BACKGROUND A foreign body reaction (FBR) is a typical tissue response to a biomaterial that has been injected or implanted in human body tissue. There has been a lack of data on the classification of foreign body reaction to silicone injection, which can describe the pattern of body tissue responses to silicone. OBJECTIVE Determine the foreign body reaction to silicone injection. METHOD We modified the classification proposed by Duranti and colleagues, which has categorized a FBR to hyaluronic acid injection into a new classification of an FBR to silicone injection. A cohort study of 31 women suffering from silicone-induced granulomas on their chin was conducted. Granulomatous tissue and submental skin were stained with hematoxylin–eosin and evaluated. RESULTS Our data revealed that there were at least 7 categories of FBRs to silicone injection that could be developed. Categories 1 to 4 showed inflammatory activity, and categories 5 to 8 showed tissue repair by fibrosis. CONCLUSION Using histopathological staining, we are able to sequence the steps of body reactions to silicone injection. Initial inflammatory reaction is then replaced by fibrosis process repairing the damaged tissues. The process depends on the host immune tolerance.
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14
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Abstract
A 56-year-old woman presented with periocular nodules that were clinically suspected to be neurofibromas. Histopathologic examination of excised nodules revealed a pronounced granulomatous reaction to a foreign material that was composed of glossy polygonal palely eosinophilic fragments. These fragments were outlined in red with Masson trichrome, stained gray with the elastic stain, and were uniformly red with Gomori methenamine silver staining. The histopathologic appearance was consistent with a granulomatous reaction to Dermalive facial filler. Postoperatively the patient admitted that she had filler injections many years earlier in another country, and that nodules appeared 1 year after injection. Treatment with steroids, intralesional immunosuppressive agents and surgery had been previously attempted to eradicate the nodules. The literature pertaining to granulomatous reactions to Dermalive and related hybrid facial fillers is reviewed and treatment options are discussed. This report is the first to illustrate the unique histopathologic staining characteristics of Dermalive, which may be useful to ophthalmic pathologists in identifying this uncommon foreign material.
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15
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Jessop ZM, Welck M, Zinser E, Garlick N, Hopkins S. Late Presentation of Infected Silicone Granulomas in the Lower Limb. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118759020. [PMID: 29511361 PMCID: PMC5826092 DOI: 10.1177/1179544118759020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/27/2018] [Indexed: 11/16/2022]
Abstract
Introduction: Dermal fillers are used for multiple cosmetic indications including gluteal and thigh augmentation. Complications, although infrequent, are increasing due to the dramatic growth of dermal filler use. Our aim was to describe how the complication of infected silicone granulomas can present following lower limb augmentation. Methods: Two cases presented with pain, oedema, and erythema at the site of previous silicone filler injection, following a considerable delay after the last injection (range 4-7 years). We collected data on their biochemistry, haematology, histology, microbiology, and imaging at the time of presentation. Results: Complications included prolonged cellulitis with recurrent abscesses at sites of previous silicone dermal filler injection. Histology revealed infiltration of chronic inflammatory cells suggestive of silicone granuloma in both cases. Patients were reluctant to divulge use of cosmetic fillers or failed to recognise their significance given the time delay making diagnosis difficult. Delayed or recurring infections can suggest the presence of atypical organisms and we present the first reported case of silicone granuloma infection with Propionibacterium acnes. Conclusions: Microorganisms can induce immune-mediated hypersensitivity and are believed to be the trigger for delayed activation of a quiescent foreign body to a granulomatous reaction. The substantial time delay between injection and reaction must be recognised and may be attributable to atypical microorganisms or biofilm formation. Previous antibiotic use can affect expedient microbiological diagnosis and treatment requires close collaboration with microbiologists. It is important that clinicians are aware of these important complications which are becoming more common with increased use of filler augmentation.
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Affiliation(s)
- Zita M Jessop
- Department of Orthopaedics, Royal Free Hospital, London, UK.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Matthew Welck
- Department of Orthopaedics, Royal Free Hospital, London, UK
| | - Emily Zinser
- Department of Orthopaedics, Royal Free Hospital, London, UK
| | | | - Susan Hopkins
- Department of Pathology, Royal Free Hospital, London, UK
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16
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Bisschop C, Bruijn M, Stenekes M, Diercks G, Hospers G. Foreign body reaction triggered by cytotoxic T lymphocyte-associated protein 4 blockade 25 years after dermal filler injection. Br J Dermatol 2016; 175:1351-1353. [DOI: 10.1111/bjd.14674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- C. Bisschop
- Department of Medical Oncology; University of Groningen; University Medical Centre Groningen; The Netherlands
| | - M.S. Bruijn
- Department of Dermatology; University of Groningen; University Medical Centre Groningen; The Netherlands
| | - M.W. Stenekes
- Department of Plastic Surgery; University of Groningen; University Medical Centre Groningen; The Netherlands
| | - G.F.H. Diercks
- Department of Pathology; University of Groningen; University Medical Centre Groningen; The Netherlands
| | - G.A.P. Hospers
- Department of Medical Oncology; University of Groningen; University Medical Centre Groningen; The Netherlands
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17
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Novo RC, Salgado CJ, Yim E, Sinha V, Chim HW, Romanelli P. A staging system for gluteal foreign body reaction to injectables. J Plast Reconstr Aesthet Surg 2016; 69:e174-9. [PMID: 27325516 DOI: 10.1016/j.bjps.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Esthetic augmentation of the gluteal region can lead to complications including debilitating pain, infections, wounds, and scars. To our knowledge, a general consensus of staging and treatment guidelines for managing gluteal foreign body reaction to injectables has not yet been established. OBJECTIVE The objective of this study was to develop a reliable staging system that can be used to implement a treatment algorithm for gluteal foreign body reactions. METHODS A retrospective review of 40 patients treated for complications of gluteal injections between September 2010 and May 2014 was performed. Patient symptoms, imaging, and photographs were used to develop a staging system of disease. Institutional review board approval was obtained from the University of Miami Miller School of Medicine. Five independent observers reviewed the patients' documented symptoms and photographs. Using our staging system, the independent observers reviewed the patient cases at two separate time intervals. Intra- and interclass correlation coefficients (ICCs) were computed to assess the reliability for each of the observers. RESULTS Seven patients were classified as Stage I, fifteen as Stage IIa, nine as Stage IIb, and nine as Stage III. The mean patient age was 34 years (21-50). Analysis of the independent reviewer results revealed ICC for each rater to range from 0.96 to 0.98, demonstrating high indexes of intra-rater reliability. CONCLUSIONS Based on our statistical analysis, we found an excellent inter- and intra-observer reliability, indicating that the staging system is reproducible and reliable. A treatment strategy dependent on the stage can be implemented as a guideline to optimize functional and esthetic outcomes.
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Affiliation(s)
- Rebecca C Novo
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher J Salgado
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Elizabeth Yim
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Varsha Sinha
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harvey W Chim
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paolo Romanelli
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Silicone-induced Granuloma After Buttock Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e624. [PMID: 27014553 PMCID: PMC4778895 DOI: 10.1097/gox.0000000000000618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Liquid silicone is inexpensive, minimally antigenic, and likely noncarcinogenic. Its simplicity of use has made it popular as a soft-tissue filler in some parts of the world for patients seeking rapid soft-tissue augmentation of the face, breast, and buttocks. However, multiple reports describe the complications of silicone injections such as cellulitis, abscess, ulceration, and foreign body migration. We present an unusual complication of granulomatous reaction secondary to silicone injection for buttock augmentation, with a literature review of this entity and treatment options. Our patient was a 54-year-old woman who underwent bilateral buttock augmentation in the Dominican Republic using percutaneous injection of liquid silicone. She presented to our facility 1 year after this procedure with pain and inflammation of both buttocks. She was diagnosed with multiple silicone granulomas. Her symptoms completely resolved with a 3-week course of minocycline. Granulomatous reactions to silicone may occur months to years after the silicone injection. The incidence of such complications may be increased when nonmedical-grade silicone is used, and hence, when these procedures are performed in developing countries. Tetracycline antibiotics, especially minocycline, may be used to achieve sustained remission.
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19
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Nasseri E. Gluteal Augmentation With Liquid Silicone of Unknown Purity Causes Granulomas in an Adult Female. J Cutan Med Surg 2015. [DOI: 10.1177/1203475415598065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A 39-year-old woman presented with a history of relapsing painful erythema and progressive fibrosis of the lower back. Upon questioning, the patient admitted to receiving liquid silicone (LS) injections for gluteal augmentation abroad and was diagnosed with silicone migration, granulomatous reaction, and fibrosis of the lower back. Objective: To review the history of LS injections for cosmetic soft tissue augmentation (STA) as well as its complications and potential treatments. Methods: The author reviewed articles that involved the use of LS for STA and summarized their findings. Results: The author summarizes the various treatments that have been described for inflammatory reactions following LS injection. Conclusion: The growth of cosmetic medical tourism and its inherent lack of after-care as well as patients’ ability to obtain restricted products at home raise the likelihood of encountering granulomatous or fibrotic reactions to fillers during consultations. Physicians should have a structured approach to these patients.
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Affiliation(s)
- Eiman Nasseri
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
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20
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de la Fuente TP, Sandoval E, Hermoso CC, Pardo LG. Mycobacterium tuberculosis silicone gluteus abscesses with bone involvement. Aesthetic Plast Surg 2014; 38:485-7. [PMID: 24584858 DOI: 10.1007/s00266-014-0281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- T Pérez de la Fuente
- Department of Plastic and Reconstructive Surgery, Fundación Jiménez Díaz, Avd/Reyes Católicos 2, 28040, Madrid, Spain,
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21
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Severe granulomatous reaction associated with hypercalcemia occurring after silicone soft tissue augmentation of the buttocks: a case report. Aesthetic Plast Surg 2014; 38:95-99. [PMID: 24281899 DOI: 10.1007/s00266-013-0167-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Liquid silicone is a permanent filler. Its use to augment soft tissues for aesthetic purposes was widespread worldwide in the 1960s. Although initially considered to be biologically inert, this substance may cause, after its injection, an inflammatory granulomatous effect of variable severity and, in very rare cases, a severe hypercalcemia, which can be life threatening. The reported case highlights the well-known physiopathology of hypercalcemia, and the various therapeutic options are discussed. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Gratch N, Weinberg JM, Alexis AF. Etanercept: a tumor necrosis factor inhibitor for psoriasis and psoriatic arthritis. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.1.4.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Silicone-induced granuloma after injection for cosmetic purposes: a rare entity of calcitriol-mediated hypercalcemia. Case Rep Med 2013; 2013:807292. [PMID: 24363673 PMCID: PMC3864076 DOI: 10.1155/2013/807292] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/18/2013] [Indexed: 11/17/2022] Open
Abstract
Hypercalcemia is often a clue to the presence of unsuspected illness. We present an interesting case of an HIV-positive transgender female with a rare cause of silicone-induced granulomatous hypercalcemia. Although there have been a few case reports of silicone injections in dialysis patients causing hypercalcemia, this metabolic derangement secondary to silicone granulomas continues to be a unique entity with an unclear pathophysiology. We present a 45-year-old transgender HIV-positive female, with extensive silicone injections, who presented with symptomatic hypercalcemia. Workup for malignancy and hyperparathyroidism was negative. 1,25-Dihydroxyvitamin D level and 24-hour urine calcium level were elevated. CT scan showed extensive high-density reticulonodular densities in the buttocks and gluteal muscle fascia extending upwards to the lumbar region, along with prominent external iliac and inguinal lymph nodes. Nuclear imaging showed diffuse heterogeneity and increased uptake in the buttocks, most consistent with granuloma calcifications, and an inguinal lymph node biopsy confirmed a foreign body giant cell reaction. The patient was started on prednisone and this resulted in decrease in serum and urinary calcium levels. Physicians should have a high index of suspicion for silicone-induced hypercalcemia considering the growing prevalence of body contour enhancement with injections, implants, and fillers using this material.
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Alijotas-Reig J, Fernández-Figueras MT, Puig L. Inflammatory, immune-mediated adverse reactions related to soft tissue dermal fillers. Semin Arthritis Rheum 2013; 43:241-58. [DOI: 10.1016/j.semarthrit.2013.02.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 02/07/2013] [Accepted: 02/15/2013] [Indexed: 12/14/2022]
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Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol 2013; 14:401-11. [PMID: 24037757 DOI: 10.1007/s40257-013-0043-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.
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Affiliation(s)
- Jennifer A Ledon
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, 2nd floor, Miami, FL, 33136, USA,
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García Callejo FJ, Calvo González J, Agustí Martínez J, Bécares Martínez C, Monzó Gandía R, Marco Algarra J. Neck lymphadenitis due to silicone granuloma after mammary implants. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:217-22. [PMID: 23499209 DOI: 10.1016/j.otorri.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A foreign body reaction due to silicone where it is infiltrated or at the places to which it can migrate is known as siliconoma. The use of silicone in breast augmentation procedures can provoke this reaction at the neck level in cases of leakage from mammary implants. METHODS We reviewed the cases of patients with increased size neck lymph nodes who had previously undergone plastic surgery of the breast with highly cohesive silicone gel implants. RESULTS In a 10-year period, we identified 12 cases with silicone-infiltrated neck lymphadenopathies, histologically confirmed by fine needle aspiration. They represented 3.5% of patients attended for neck lymph node study. We removed those detected by physical examination and CT in 5 cases, due to pathological characteristics of the node or a previous malignant history. In 2 of these nodes recurred, and node size also increased in 2 of the other 7 non-operated cases. After implant removal, silicone leakage was observed in only 7 cases. CONCLUSIONS Cohesive gel silicone used for mammary implants can generate increased neck lymphadenopathies as a secondary effect due to systemic reactions against the silicone when it migrates in cases of implant failure. Surgical options for involved nodes usually do not offer good long-term results.
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Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg 2012; 5:121-32. [PMID: 23060707 PMCID: PMC3461789 DOI: 10.4103/0974-2077.99451] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.
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Affiliation(s)
- Lauren L Levy
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Ultrasound-assisted liposuction as a safe and effective method for the removal of siliconomas. Aesthetic Plast Surg 2012; 36:220-2. [PMID: 21701943 DOI: 10.1007/s00266-011-9778-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alijotas-Reig J, Garcia-Gimenez V, Vilardell-Tarrés M. Tacrolimus in the Treatment of Chronic and Refractory Late-Onset Immune-Mediated Adverse Effects Related to Silicone Injections. Dermatol Surg 2012; 38:38-47. [DOI: 10.1111/j.1524-4725.2011.02221.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Duffy DM. Commentary: Tacrolimus in the Treatment of Chronic and Refractory Late-Onset Immune-Mediated Adverse Effects Related to Silicone Injections. Dermatol Surg 2012; 38:48-50. [DOI: 10.1111/j.1524-4725.2011.02220.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moscona RA, Fodor L. A retrospective study on liquid injectable silicone for lip augmentation: Long-term results and patient satisfaction. J Plast Reconstr Aesthet Surg 2010; 63:1694-8. [DOI: 10.1016/j.bjps.2009.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 10/03/2009] [Accepted: 10/13/2009] [Indexed: 11/16/2022]
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Kluger N, Plantier F, Carlotti A, Guillevin L. Facial granuloma after occult silicone injection (siliconoma): a diagnosis not to be missed. Eur J Intern Med 2009; 20:e120-1. [PMID: 19712832 DOI: 10.1016/j.ejim.2008.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/03/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
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Guhl G, Díaz-Ley B, Fernández-Herrera J. Uso de fármacos biológicos en dermatosis fuera de la indicación aprobada. Segunda parte: etanercept, efalizumab, alefacept, rituximab, daclizumab, basiliximab, omalizumab y cetuximab. ACTAS DERMO-SIFILIOGRAFICAS 2008; 99:5-33. [DOI: 10.1016/s0001-7310(08)74612-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Off-Label Use of Biologic Agents in the Treatment of Dermatosis, Part 2: Etanercept, Efalizumab, Alefacept, Rituximab, Daclizumab, Basiliximab, Omalizumab, and Cetuximab. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kroshinsky D, Grossman ME, Fox LP. Approach to the Patient With Presumed Cellulitis. ACTA ACUST UNITED AC 2007; 26:168-78. [DOI: 10.1016/j.sder.2007.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kerns MJJ, Graves JE, Smith DI, Heffernan MP. Off-Label Uses of Biologic Agents in Dermatology: A 2006 Update. ACTA ACUST UNITED AC 2006; 25:226-40. [PMID: 17174843 DOI: 10.1016/j.sder.2006.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include adalimumab, alefacept, efalizumab, etanercept, infliximab, IVIg, omalizumab, and rituximab. Most dermatologists are familiar with the indications of these medications that have been approved by the Food and Drug Administration; however, numerous off-label uses have evolved. To update the reader on more recent uses of the biologics for off-label dermatologic use, this article will emphasize more recent published data from 2005 through the date of submission in May 2006.
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Furst DE, Breedveld FC, Kalden JR, Smolen JS, Burmester GR, Emery P, Keystone EC, Schiff MH, van Riel PLCM, Weinblatt ME, Weisman MH. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2006. Ann Rheum Dis 2006; 65 Suppl 3:iii2-15. [PMID: 17038465 PMCID: PMC1798383 DOI: 10.1136/ard.2006.061937] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- D E Furst
- David Geffen School of Medicine, UCLA - RM 32-59, 1000 Veteran Avenue, Los Angeles, CA 90025, USA.
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Zeichner JA, Stern DWK, Lebwohl M. Treatment of necrobiosis lipoidica with the tumor necrosis factor antagonist etanercept. J Am Acad Dermatol 2006; 54:S120-1. [PMID: 16488322 DOI: 10.1016/j.jaad.2005.11.1042] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 11/10/2005] [Accepted: 11/12/2005] [Indexed: 11/20/2022]
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Roche E, Pitarch G, Vilata JJ. [Labial swelling which had developed over two months]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:706-8. [PMID: 16476326 DOI: 10.1016/s0001-7310(05)73164-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Elena Roche
- Servicio de Dermatología, Hospital General Universitario de Valencia, Spain.
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Abstract
Etanercept (Enbrel, Wyeth Pharmaceuticals) is a fusion protein composed of a soluble TNF alpha receptor issued from bio-technology. It is a member of TNF alpha's family with two others marked infliximab (Remicade, Scheringh Plough Laboratory), chimeric monoclonal antibody (25 p. 100 mouse) and adalimumab (Humira, Abbott France Laboratory), humanized monoclonal antibody (100 p. 100 human). In United States, etanercept is approved by Food and Drug Administration, since 1998, to treat rheumatoid arthritis showing an inadequate response to prior therapy with other disease-modifying antirheumatic drugs (DMARDS). In France, the MA (Marketing Authorization) is more recent, in 2000, etanercept to treat active rheumatoid arthritis who showed an inadequate response to others DMARDS (like methotrexate for example), with opportunity, in 2002, to administer etanercept in active, severe RA, in first line treatment without previous use of methotrexate. Others MA have been obtained in ankylosing spondylitis (2004) polyarticular-course juvenile rheumatoid arthritis (2000), and in the treatment of psoriasic arthritis (2002). Request of MA have been realised to treat cutaneous mild to severe psoriasis in adult, which failed to respond, contradication or no tolerance with systemic treatment as methotrexate, cyclosporine or phototherapy. Among the others anti-TNF therapy, only infliximab can be prescribed, in dermatology, to treat psoriatic arthritis in France. Encouraging good results were the subject of cases report, but lacking clinical trial, predicting probably administration of etanercept in others indications in future. TNF alpha is a proinflammatory cytokine and plays an important role in the physiopathology of large inflammatory diseases. Logically, in future, we should increased prescription of biotherapy, particularly anti-TNF alpha. We have to mind short or mild-term adverse events, widely described in the literature, but long-term side effects remained unknown. Moreover, these biotherapic agents have a high cost and should be estimate.
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Affiliation(s)
- A Sparsa
- Service de Dermatologie, Hôpital Universitaire Dupuytren, Limoges.
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