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Mechanisms of Foreign Body Giant Cell Formation in Response to Implantable Biomaterials. Polymers (Basel) 2023; 15:polym15051313. [PMID: 36904554 PMCID: PMC10007405 DOI: 10.3390/polym15051313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
Long term function of implantable biomaterials are determined by their integration with the host's body. Immune reactions against these implants could impair the function and integration of the implants. Some biomaterial-based implants lead to macrophage fusion and the formation of multinucleated giant cells, also known as foreign body giant cells (FBGCs). FBGCs may compromise the biomaterial performance and may lead to implant rejection and adverse events in some cases. Despite their critical role in response to implants, there is a limited understanding of cellular and molecular mechanisms involved in forming FBGCs. Here, we focused on better understanding the steps and mechanisms triggering macrophage fusion and FBGCs formation, specifically in response to biomaterials. These steps included macrophage adhesion to the biomaterial surface, fusion competency, mechanosensing and mechanotransduction-mediated migration, and the final fusion. We also described some of the key biomarkers and biomolecules involved in these steps. Understanding these steps on a molecular level would lead to enhance biomaterials design and improve their function in the context of cell transplantation, tissue engineering, and drug delivery.
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Complicated Facial Fillers: Management Algorithm. Plast Reconstr Surg Glob Open 2022; 10:e4445. [PMID: 35923984 PMCID: PMC9307301 DOI: 10.1097/gox.0000000000004445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
Background: Various materials have been developed as skin fillers to correct wrinkles of the face. Dermal fillers are classified based on their biodegradability into bioresorbable versus nonbioresorbable. All dermal fillers have a potential risk of complications, which can be classified as early and late onset events. Among all the complications of filler injections, inflammatory nodules and granulomas are the most annoying and disfiguring. The purpose of the study was to provide a surgical treatment algorithm that allows us to deal with the complications of facial fillers through three surgical techniques. Methods: Thirty-one patients with complaints of facial contour abnormalities after filler injection, three surgical techniques were adopted according to the presenting case including face lift incision, needle aspiration and intraoral excision after preoperative preparation of the case with postoperative follow-up for 6 months. Results: Among our studied patients treated by these surgical techniques, dissection was difficult owing to the fibrosis and the granulomatous reaction post complicated filler injection. There were two cases of hematoma, 1 case of seroma, and 1 case of facial nerve injury that improved after 4 months, in which marked improvement of facial contour and skin quality was observed. Conclusions: The use of the facelift technique as a surgical treatment for post filler complication granuloma excision provides a useful and satisfactory method for patients complaining of major facial deformities following repeated complicated filler injections. Despite being more difficult than other techniques it is more satisfactory in facial rejuvenation post complicated facial fillers.
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3
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Adamczyk K, Rusyan E, Franek E. Safety of Aesthetic Medicine Procedures in Patients with Autoimmune Thyroid Disease: A Literature Review. Medicina (B Aires) 2021; 58:medicina58010030. [PMID: 35056337 PMCID: PMC8779514 DOI: 10.3390/medicina58010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/06/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Autoimmune thyroid diseases are the most common organ-specific autoimmune diseases, affecting 2–5% of the world’s population. Due to the autoimmune background of thyroid diseases, we analyzed a wide range of cosmetic procedures, from minimally invasive cosmetic injections (mesotherapy) to highly invasive procedures, such as lifting threads. Out of the seven categories of treatments in aesthetic medicine analyzed by us—hyaluronic acid, botulinum toxin, autologous platelet-rich plasma, autologous fat grafting, lifting threads, IPL and laser treatment and mesotherapy—only two, mesotherapy and lifting threads, are not recommended. This is due to the lack of safety studies and the potential possibility of a higher frequency of side effects in patients with autoimmune thyroid diseases.
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Affiliation(s)
- Kamil Adamczyk
- Adamczyk Clinic, Żyzna 4, 03-613 Warsaw, Poland;
- Clinic of Anaesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Wołoska 137, 02-507 Warsaw, Poland
| | - Ewa Rusyan
- Department of Conservative Dentistry, Warsaw Medical University, Żwirki I Wigury 61, 02-091 Warsaw, Poland;
| | - Edward Franek
- Clinic of Internal Medicine, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Wołoska 137, 02-507 Warsaw, Poland
- Correspondence: ; Tel.: +48-(47)-722-14-05
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Abstract
BACKGROUND There is no standardized approach for nonsurgical techniques for penile augmentation despite the increase of demand for this intervention. OBJECTIVE To compare the efficacy and safety between different injection techniques. MATERIALS AND METHODS On October 8, 2019, a literature search was performed on PubMed, Embase, Ovid, and Cochrane database. All articles describing penile augmentation were included. RESULTS Thirteen studies were included in this article with a total of 1,311 patients. Five studies were prospective cohort. The most commonly described technique was hyaluronic acid fillers with a total of 4 articles and 205 patients. The mean injected volume ranged from 20 to 40 mL. In all included studies, a minority of patients had side effects, but some had disabling complications. CONCLUSION There are no defined clinical guidelines for penile augmentation techniques implemented yet. Hyaluronic acid seems to be safe, efficient, and with a high satisfaction score. Further randomized control trials are warranted. EBM LEVEL OF EVIDENCEBASED MEDICINE 2a.
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Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation. Aesthetic Plast Surg 2020; 44:1348-1360. [PMID: 32766911 DOI: 10.1007/s00266-020-01827-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lackexperimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months.Host defense mechanisms react differently to the various filler materials, but all substances- resorbable or nonresorbable-appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances.
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6
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Shue A, Joseph JM, Tao JP, Barker-Griffith AE, Abraham JL, Minckler DS. Massive Silicone-Induced Orbital Granuloma. Ocul Oncol Pathol 2019; 6:145-150. [PMID: 32258023 DOI: 10.1159/000501295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
We report a large subconjunctival-orbital granuloma in a 51-year-old male presenting with a blind painful right eye and marked chemosis 15 months after undergoing vitrectomy and silicone oil retinal tamponade for retinal detachment with no reported intraoperative complications. Gross and histopathologic examination of the enucleated eye and episcleral tumor revealed a bosselated mass measuring 17 × 10 × 5 mm containing prominent vacuoles with surrounding epithelioid histiocytes and foreign body multinucleated giant cells. Such a large silicone-induced orbital granuloma following uncomplicated retinal surgery in a grossly intact eye has not been previously reported to the authors' knowledge. High intraocular pressure and emulsification of oil may facilitate silicone extravasation through scleral wounds after retinal surgery.
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Affiliation(s)
- Ann Shue
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Jeffrey M Joseph
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Ann E Barker-Griffith
- Department of Ophthalmology, SUNY, Upstate Medical University, Syracuse, New York, USA.,Department of Pathology, SUNY, Upstate Medical University, Syracuse, New York, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY, Upstate Medical University, Syracuse, New York, USA
| | - Donald S Minckler
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
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7
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Exenatide-Induced Panniculitis: Utility of the Acid-Fast Stain to Identify Injected Microspheres. Am J Dermatopathol 2019; 40:867-869. [PMID: 28700374 DOI: 10.1097/dad.0000000000000952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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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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9
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Fernández-Flores A. Morphology of rare exogenous materials in dermatopathology. J Cutan Pathol 2017; 44:237-248. [DOI: 10.1111/cup.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/14/2016] [Accepted: 12/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Angel Fernández-Flores
- Department of Cellular Pathology; Hospital El Bierzo; Ponferrada Spain
- CellCOM-ST Group; Biomedical Investigation Institute of A Coruña; A Coruña Spain
- Department of Cellular Pathology; Hospital de la Reina; Ponferrada Spain
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10
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Bilateral Eyelid Pseudoptosis From Lipogranulomas of the Preaponeurotic Fat Pads. Ophthalmic Plast Reconstr Surg 2016; 31:e125-31. [PMID: 24841730 DOI: 10.1097/iop.0000000000000157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lipogranulomas of the periocular tissues with fulminant fibrotic and lymphohistiocytic responses were initially described in cases of exogenous paraffin or petrolatum jelly injections ("paraffinomas"). A 49-year-old Cambodian woman slowly developed bilateral pseudoptosis with intact levator function and redundant, taut upper eyelid skin. At surgery, vesiculations or "bubbles" in the preaponeurotic fat were encountered and were demonstrated histopathologically to be empty locules surrounded by a thin collagenous lamina. Outside these extracellular spaces were CD68/CD163-positive mononucleated and univacuolated histiocytes simulating damaged fat cells or neoplastic lipoblasts in hematoxylin and eosin sections. Giant cells and chronic sclerosing inflammation were absent. The patient denied any previous injections. The bland character of the lipogranulomas in comparison with that of other injectable agents, the absence of any residual particles associated with other cosmetic fillers, and the distinctive histiocytic response of lipoblast-like cells that were sufficiently characteristic to compel the diagnosis of surreptitious silicone injections. Other conditions were excluded based on comparative clinicopathologic criteria.
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11
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Abstract
A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.
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Affiliation(s)
- Ana M Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain.
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain
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12
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Abstract
Any injectable filler may elicit moderate-to-severe adverse events, ranging from nodules to abscesses to vascular occlusion. Fortunately, severe adverse events are uncommon for the majority of fillers currently on the market. Because these are rare events, it is difficult to identify the relevant risk factors and to design the most efficacious treatment strategies. Poor aesthetic outcomes are far more common than severe adverse events. These in contrast should be easily avoidable by ensuring that colleagues receive proper training and follow best practices.
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13
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Affiliation(s)
- John H Joseph
- 9400 Brighton Way, Suite 203, Beverly Hills, CA 90210, USA.
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14
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de Jesus LH, de Campos Hildebrand L, Martins MD, da Rosa FM, Danilevicz CK, Sant'Ana Filho M. Location of injected polymethylmethacrylate microspheres influences the onset of late adverse effects: an experimental and histopathologic study. Clin Cosmet Investig Dermatol 2015; 8:431-6. [PMID: 26346665 PMCID: PMC4531029 DOI: 10.2147/ccid.s81467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Polymethylmethacrylate (PMMA) has been widely used in the correction of wrinkles because of its long-lasting cosmetic improvements. However, side effects and complications may occur, and its clinical appearance on the oral mucosa can be similar to that of inflammatory or neoplastic disease. The aim of this research was to compare the clinical and histopathologic responses to PMMA injected by two different methods. Twenty-two rats received an injection of PMMA using the tunneling technique (gold standard), with subcutaneous deposition of the filler in the face, or a variation of the technique with transcutaneous submucosal deposition of the filler in the cheek. The tissue reaction was analyzed clinically every 24 hours during the first week, then once a week for the following 3 months. Histologic evaluation was based on the local inflammatory response to the filler. No clinical changes were observed during the initial evaluation period (0-14 days). After 14 days, only the submucosal group showed extra-oral enlargement (n=4, 18.2%). Histopathologic analysis revealed nodule formation in four animals (18.2%) in the submucosal group, with no nodules observed in the subcutaneous group. The data obtained in this study demonstrate that the technique used to deliver the filler may influence the risk of adverse reactions.
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Affiliation(s)
- Luciano Henrique de Jesus
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Laura de Campos Hildebrand
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Francinne Miranda da Rosa
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Chris Krebs Danilevicz
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Manoel Sant'Ana Filho
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Alijotas-Reig J. Human adjuvant-related syndrome or autoimmune/inflammatory syndrome induced by adjuvants. Where have we come from? Where are we going? A proposal for new diagnostic criteria. Lupus 2015; 24:1012-8. [PMID: 25813870 DOI: 10.1177/0961203315579092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/02/2015] [Indexed: 12/21/2022]
Abstract
In 1964, Miyoshi reported a series of patients with diverse symptoms after receiving treatment with silicone or paraffin fillers. Miyoshi named this condition 'human adjuvant disease'. Since then, the literature has been flooded with case reports and case series of granulomatous and systemic autoimmune disorders related to vaccines, infection or other adjuvants such as silicone and other biomaterials. A new term -autoimmune/inflammatory syndrome induced by adjuvants--has recently been coined for a process that includes several clinical features previously described by Miyoshi plus other clinical and laboratory parameters related to exposure to diverse external stimuli. Disorders such as siliconosis, Gulf War syndrome, macrophagic myofasciitis syndrome, sick building syndrome and post-vaccination syndrome have been included in autoimmune/inflammatory syndrome induced by adjuvants. Disorders such as Spanish toxic oil syndrome and Ardystil syndrome could also be included. Furthermore, biomaterials other than silicone should also be considered as triggering factors for these adjuvant-related syndromes. New diagnostic criteria in this field have been proposed. Nevertheless, many of these criteria are too subjective, leading to some patients being diagnosed with chronic fatigue syndrome or other 'central sensitization syndromes'. Diagnostic criteria based only on objective clinical and laboratory data to be further discussed and validated are proposed herein.
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Affiliation(s)
- J Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebron UniversityHospital, Barcelona, Spain Faculty of Medicine, Universitat Autonoma, Barcelona, Spain
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16
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Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment. Arch Plast Surg 2015; 42:232-9. [PMID: 25798398 PMCID: PMC4366708 DOI: 10.5999/aps.2015.42.2.232] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/03/2014] [Accepted: 09/18/2014] [Indexed: 11/08/2022] Open
Abstract
A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.
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17
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Di Girolamo M, Mattei M, Signore A, Grippaudo FR. MRI in the evaluation of facial dermal fillers in normal and complicated cases. Eur Radiol 2014; 25:1431-42. [PMID: 25477273 DOI: 10.1007/s00330-014-3513-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/01/2014] [Accepted: 11/17/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To ascertain by MRI the presence of filler injected into facial soft tissue and characterize complications by contrast enhancement. METHODS Nineteen volunteers without complications were initially investigated to study the MRI features of facial fillers. We then studied another 26 patients with clinically diagnosed filler-related complications using contrast-enhanced MRI. TSE-T1-weighted, TSE-T2-weighted, fat-saturated TSE-T2-weighted, and TIRM axial and coronal scans were performed in all patients, and contrast-enhanced fat-suppressed TSE-T1-weighted scans were performed in complicated patients, who were then treated with antibiotics. Patients with soft-tissue enhancement and those without enhancement but who did not respond to therapy underwent skin biopsy. Fisher's exact test was used for statistical analysis. RESULTS MRI identified and quantified the extent of fillers. Contrast enhancement was detected in 9/26 patients, and skin biopsy consistently showed inflammatory granulomatous reaction, whereas in 5/17 patients without contrast enhancement, biopsy showed no granulomas. Fisher's exact test showed significant correlation (p < 0.001) between subcutaneous contrast enhancement and granulomatous reaction. Cervical lymph node enlargement (longitudinal axis >10 mm) was found in 16 complicated patients (65 %; levels IA/IB/IIA/IIB). CONCLUSIONS MRI is a useful non-invasive tool for anatomical localization of facial dermal filler; IV gadolinium administration is advised in complicated cases for characterization of granulomatous reaction. KEY POINTS • MRI is a non-invasive tool for facial dermal filler detection and localization. • MRI-criteria to evaluate complicated/non-complicated cases after facial dermal filler injections are defined. • Contrast-enhanced MRI detects subcutaneous inflammatory granulomatous reaction due to dermal filler. • 65 % patients with filler-related complications showed lymph-node enlargement versus 31.5 % without complications. • Lymph node enlargement involved cervical levels (IA/IB/IIA/IIB) that drained treated facial areas.
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Affiliation(s)
- Marco Di Girolamo
- Radiology Unit, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy,
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18
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Rongioletti F, Atzori L, Ferreli C, Pau M, Pinna AL, Mercuri SR, Aste N, Fraitag S. Granulomatous reactions after injections of multiple aesthetic micro-implants in temporal combinations: a complication of filler addiction. J Eur Acad Dermatol Venereol 2014; 29:1188-92. [DOI: 10.1111/jdv.12788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/19/2014] [Indexed: 11/30/2022]
Affiliation(s)
- F. Rongioletti
- Department of Health Sciences; IRCSS-AOU S.Martino-IST; DISSAL; Section of Dermatology; University of Genoa; Genoa Italy
- Department of Surgical and Morphological Sciences; Anatomic Pathology Division; IRCSS-AOU S.Martino; University of Genoa; Genoa Italy
| | - L. Atzori
- Mario Aresu Department of Medical Science; Section of Dermatology; University of Cagliari; Italy
| | - C. Ferreli
- Mario Aresu Department of Medical Science; Section of Dermatology; University of Cagliari; Italy
| | - M. Pau
- SC of Dermatology; AOU Cagliari; Italy
| | | | - S. R. Mercuri
- Dermatology Unit; IRCSS San Raffaele; Università Vita-Salute; Milano Italy
| | - N. Aste
- Mario Aresu Department of Medical Science; Section of Dermatology; University of Cagliari; Italy
| | - S. Fraitag
- Department of Pathology; Hopital Necker-Enfants Malades; AP-HP; Université Paris Descartes; France
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19
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Alhede M, Bjarnsholt T. Are biofilms responsible for the adverse effects experienced following soft-tissue fillers? Future Microbiol 2014; 9:931-3. [PMID: 25302951 DOI: 10.2217/fmb.14.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Morten Alhede
- Costerton Biofilm Center, Department of International Health, Immunology, & Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Abstract
: The cutaneous deposition disorders are a group of unrelated conditions characterized by the accumulation of either endogenous or exogenous substances within the skin. These cutaneous deposits are substances that are not normal constituents of the skin and are laid down usually in the dermis, but also in the subcutis, in a variety of different circumstances. There are 5 broad categories of cutaneous deposits. The first group includes calcium salts, bone, and cartilage. The second category includes the hyaline deposits that may be seen in the dermis in several metabolic disorders, such as amyloidosis, gout, porphyria, and lipoid proteinosis. The third category includes various pigments, heavy metals, and complex drug pigments. The fourth category, cutaneous implants, includes substances that are inserted into the skin for cosmetic purposes. The fifth category includes miscellaneous substances, such as oxalate crystals and fiberglass. In this article, the authors review the clinicopathologic characteristics of cutaneous deposition diseases, classify the different types of cutaneous deposits, and identify all the histopathologic features that may assist in diagnosing the origin of a cutaneous deposit.
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21
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Requena C, Requena L, Alegre V, Serra C, Llombart B, Nagore E, Guillén C, Sanmartín O. Adverse reaction to silicone simulating orofacial granulomatosis. J Eur Acad Dermatol Venereol 2014; 29:998-1001. [DOI: 10.1111/jdv.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C. Requena
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - L. Requena
- Department of Dermatology; Fundación Jiménez Díaz; Madrid Spain
| | - V Alegre
- Department of Dermatology; Consorcio Hospital General Universitario; Valencia Spain
| | - C. Serra
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - B. Llombart
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - E. Nagore
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - C. Guillén
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - O. Sanmartín
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
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22
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Alijotas-Reig J, Fernández-Figueras MT, Puig L. Late-onset inflammatory adverse reactions related to soft tissue filler injections. Clin Rev Allergy Immunol 2014; 45:97-108. [PMID: 23361999 DOI: 10.1007/s12016-012-8348-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An ever-increasing number of persons seek medical solutions to improve the appearance of their aging skin or for aesthetic and cosmetic indications in diverse pathological conditions, such as malformations, trauma, cancer, and orthopedic, urological, or ophthalmological conditions. Currently, physicians have many different types of dermal and subdermal fillers, such as non-permanent, permanent, reversible, or non-reversible materials. Despite the claims of manufacturers and different authors that fillers are non-toxic and non-immunogenic or that complications are very uncommon, unwanted side effects do occur with all compounds used. Implanted, injected, and blood-contact biomaterials trigger a wide variety of adverse reactions, including inflammation, thrombosis, and excessive fibrosis. Usually, these adverse reactions are associated with the accumulation of large numbers of mononuclear cells. The adverse reactions related to fillers comprise a broad range of manifestations, which may appear early or late and range from local to systemic. Clinicians should be aware of them since the patient often denies the antecedent of injection or is unaware of the material employed. Most of these adverse effects seem to have an immunological basis, the fillers acting more as adjuvants than as direct T-cell activators, on a background of genetic predisposition. Their treatment has not been the subject of well-designed studies; management of both acute and systemic reactions is often difficult, and requires anti-inflammatory and occasionally immunosuppressive therapy. The clinical, pathological, and therapeutic aspects of inflammatory and immune-mediated late-onset adverse reactions related to soft tissue filler injections are thoroughly reviewed herein.
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Affiliation(s)
- Jaume Alijotas-Reig
- Ageing and Systemic Autoimmune Diseases Research Unit, Service of Internal Medicine-I, Aging Basic Research Unit, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron University Hospital, Barcelona, Spain.
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Abstract
The ideal soft-tissue filler for wrinkles and skin defects should be safe, biocompatible, resistant to phagocytosis, persist and maintain its volume without being resorbed or degraded. ArteFill, an improved, next-generation derivative of Artecoll, is expected to become the first and only FDA-approved permanent filler for use in the USA in 2006 and will be available worldwide. ArteFill consists of polymethylmethacrylate microspheres suspended in a 3.5% solution of bovine collagen containing 0.3% lidocaine. In this article, the pathophysiology, efficacy and safety of ArteFill are discussed and details of its injection technique are provided. Insight into the pharmacoeconomic value of ArteFill over nonpermanent fillers and ArteFill's unique role in the growing world market of dermal fillers is provided.
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Affiliation(s)
- Kevin W Broder
- Fresh Start Craniofacial Fellow, Clinical Instructor, University of California, Division of Plastic and Reconstructive Surgery, San Diego, CA, USA.
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Cecchi R, Spota A, Frati P, Muciaccia B. Migrating Granulomatous Chronic Reaction from Hyaluronic Acid Skin Filler (Restylane): Review and Histopathological Study with Histochemical Stainings. Dermatology 2013; 228:14-7. [DOI: 10.1159/000356421] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022] Open
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de Vries CGJCA, Geertsma RE. Clinical data on injectable tissue fillers: a review. Expert Rev Med Devices 2013; 10:835-53. [PMID: 24164663 DOI: 10.1586/17434440.2013.839211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment with injectable tissue fillers for aesthetic purposes is increasingly popular. In parallel with this success, questions related to the safety of these treatments and the products involved are being raised more prominently. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers. We found several case reports where serious complications after more than three years are described. However, there are only a limited number of well-defined prospective clinical studies available with follow-up periods longer than three years. Furthermore, causes of complications, that is, treatment or product related, are often not specified in literature. Considering the intended functional period of fillers in combination with the known occurrence of long-term complications, there is a need for well-defined prospective clinical studies. In order to be able to discriminate between product failure (a product safety issue) or application methodology (a physician expertise or training issue), better identification of observed complications and whether they are product or treatment related, is needed. For the safe use of the fillers it is important that treatment with injectable tissue fillers is performed by a trained physician, who knows the product specifications and its applications.
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Affiliation(s)
- Claudette G J C A de Vries
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, NL-3720 BA Bilthoven, The Netherlands
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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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Lee SC, Kim JB, Chin BR, Kim JW, Kwon TG. Inflammatory granuloma caused by injectable soft tissue filler (Artecoll). J Korean Assoc Oral Maxillofac Surg 2013; 39:193-6. [PMID: 24471042 PMCID: PMC3858123 DOI: 10.5125/jkaoms.2013.39.4.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 11/22/2022] Open
Abstract
Artecoll (Artes Medical Inc., San Diego, CA, USA) has recently been developed as a permanent synthetic cosmetic filler. We experienced an inflammatory granuloma resulting from a previous injection of Artecoll at the upper lip, which was regarded as a rare side effect of this filler. A 50-year-old female patient complained of swelling, dull pain, and heat in the right upper nasolabial fold area, which had started one week before her visit to Kyungpook National University Hospital. The patient received topical steroid therapy at a local clinic, which was not effective. At the injection site, a hard nodule was palpated and erythema was observed with mild tenderness. Antibiotic treatment and subsequent incision and drainage did not result in complete cure of the facial swelling, and the facial swelling and pain persisted. Computed tomography showed a lesion approximately 1-cm in size without clear boundaries and relatively increased nodular thickening. Finally, a subdermal lesion was removed via an intraoral vestibular approach. The lesion was diagnosed as inflammatory granuloma by a permanent biopsy. The patient had healed at two months after the filler injection. Although the soft tissue filler is widely used for cosmetic purposes, there is potential for complication, such as the inflammatory granuloma should be considered before treatment.
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Affiliation(s)
- Sang-Chang Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Jong-Bae Kim
- Department of Dentistry, Keimyung University College of Medicine, Daegu, Korea
| | - Byung-Rho Chin
- Department of Dentistry, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
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Adverse late reactions after cosmetic implantation of hydroxyethylmethacrylate particles suspended in hyaluronic acid: clinics and complication management. Aesthetic Plast Surg 2013; 37:576-86. [PMID: 23571782 DOI: 10.1007/s00266-013-0107-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The late-stage clinical course, histopathologic analysis, and surgical salvage procedures after eventful cosmetic injection of hydroxyethylmethacrylate particles suspended in hyaluronic acid (DermaLive, marketed through Dermatech, Paris, France and Novamedical GmbH, Langenfeld, Germany) have been studied. The study was designed to present modified treatment guidelines, report results, and draw conclusions regarding the future management of patients with late-stage DermaLive complications. METHODS The study consulted and reviewed 21 patients with late-stage complications after facial implantation of DermaLive. Histology samples from excisional biopsies followed by radical surgical excision procedures were obtained and analyzed for nine patients. RESULTS The treated zones included nasolabial folds, forehead and glabella, lips, and the perioral and zygoma regions. The late-onset period between injection and first symptoms averaged 17.5 months. Lesions were mostly symptomatic, with discomfort, pain, swelling, and edema. Clinical aspects included bulging, palpable nodules, erythema, and scar formation. A positive correlation between patient age and the delay period was found. All surgically treated patients recovered well. The initial conservative measures achieved only partial success, whereas all nine surgically treated patients (43 %) demonstrated complete relief of their clinical symptoms. CONCLUSIONS Soft tissue augmentation with DermaLive led to a series of severe delayed adverse reactions. Sclerosing DermaLive granulomas demonstrated low success rates with conservative measures, whereas early radical surgical excision achieved good results. LEVEL OF EVIDENCE IV 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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Abstract
Dermal filling has rapidly become one of the most common procedures performed by clinicians worldwide. The vast majority of treatments are successful and patient satisfaction is high. However, complications, both mild and severe, have been reported and result from injection of many different types of dermal fillers. In this Continuing Medical Education review article, the author describes common technical errors, the signs and symptoms of both common and rare complications, and management of sequelae in clear, easily adaptable treatment algorithms.
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Carlos-Fabuel L, Marzal-Gamarra C, Martí-Álamo S, Mancheño-Franch A. Foreign body granulomatous reactions to cosmetic fillers. J Clin Exp Dent 2012; 4:e244-7. [PMID: 24558563 PMCID: PMC3917632 DOI: 10.4317/jced.50868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The use of different facial cosmetic fillers has increased in recent years. The introduction of apparently inert substances in the epidermis can give rise to foreign body granulomatous reactions. Objetives: A literature review is made of the foreign body granulomatous reactions to cosmetic fillers. MATERIAL AND METHODS A PubMed-Medline search was made using the following keywords: "granulomatous reactions", "foreign body reactions", "esthetic fillers", "cosmetic fillers". The search was limited to articles published in English and Spanish during the last 10 years. A total of 22 articles were reviewed. RESULTS A great variety of substances have been found to give rise to foreign body granulomatous reactions. The most common locations are the upper and lower lip and the nasogenian sulcus. The clinical presentation is variable and can range from single or multiple nodules to diffuse facial swelling of hard-elastic consistency, accompanied by reddening. Most lesions are asymptomatic or cause only mild discomfort. The literature describes different treatments, including systemic corticosteroids, local tacrolimus infiltrations, minocycline, retinoids, allopurinol, 5% imiquimod, and surgical removal. CONCLUSIONS In view of the current demand for esthetic treatments, the use of cosmetic fillers can be expected to increase in future, together with the incidence of complications. Key words:Esthetic fillers, granulomatous reactions, foreign body reactions, cosmetic fillers.
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Affiliation(s)
- Laura Carlos-Fabuel
- DDS. Master in Oral Medicine and Surgery. University of Valencia. Valencia (Spain)
| | | | - Silvia Martí-Álamo
- DDS. Master in Oral Medicine and Surgery. University of Valencia. Valencia (Spain)
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Alijotas-Reig J, Garcia-Gimenez V, Llurba E, Vilardell-Tarrés M. Autoimmune/inflammatory syndrome (ASIA) induced by biomaterials injection other than silicone medical grade. Lupus 2012; 21:1326-34. [PMID: 22952322 DOI: 10.1177/0961203312458838] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Systemic autoimmune/granulomatous adverse reactions related to biomaterials other than silicone have rarely been reported. AIM The aim of this paper is to communicate the cases of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in a study of Spanish patients suffering from inflammatory disorders related to biomaterial injections other than silicone, principally hyaluronic acid, acrylamides or methacrylate compounds. METHODS The authors performed a retrospective analysis of the clinical, laboratory, histopathology and follow-up of a cohort of 250 cases of patients suffering from inflammatory/autoimmune disorders related to bioimplant injections. RESULTS Of these 250 cases, patients with adverse reactions related to silicone injections (n = 65) were excluded. Of the remaining 185, 15 cases (8%) had systemic or distant and multiple complaints that could be categorized as ASIA. In all but four patients, inflammatory features at the implantation site preceded distant or systemic manifestations. Abnormal blood tests were common. Eleven cases (73.3%) with inflammatory localized nodules and panniculitis evolved into a variety of disorders, namely, primary biliary cirrhosis, Sjögren's syndrome, sarcoidosis, human adjuvant disease and inflammatory polyradiculopathy. Four cases presented primarily with systemic autoimmune disorders. CONCLUSIONS Infrequently, biomaterials other than silicone can provoke local inflammatory adverse reactions that may evolve into systemic autoimmune and/or granulomatous disorders. Whether or not these biomaterials act as an adjuvant, they could be included in the ASIA category.
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Affiliation(s)
- J Alijotas-Reig
- Ageing Research and Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebron University Hospital, Spain.
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Adverse results with PMMA fillers. Aesthetic Plast Surg 2012; 36:955-63. [PMID: 22437333 DOI: 10.1007/s00266-012-9871-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 01/02/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various alloplastic materials have been used for filling depressions and for body contouring. Among them, polymethylmethacrylate (PMMA) has provoked many clinical compilations in both the acute and chronic phases. This study shows the correlation between the clinical application of PMMA and the physiopathology of the acute and late complications. METHODS Histological studies were performed on biopsy samples from patients who presented with side effects and acute and late complications after PMMA injections given at other health-care centers or aesthetic services. RESULTS The histological findings of the samples that were harvested from patients who developed clinical complications or side effects caused by injection of PMMA disclosed not only normal tissues from the implanted areas but also development of capsules that involved individual microspheres of PMMA, and when the capsules were close together they formed concentric capsular groups involving various sets of microspheres and their capsules. CONCLUSIONS The injection of PMMA within the tissues can cause severe complications and side effects in both acute and chronic phases. Initially, the complications are related to vascular compromise, but at the late phase they are a consequence of capsular contracture that involves particles of PMMA. The contracture causes local tissue hardening and clinical nodulation of the implanted areas, ending with extrusion of the filler material. LEVEL OF EVIDENCE IV 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 at www.springer.com/00266.
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Requena L, Cerroni L, Kutzner H. Histopathologic patterns associated with external agents. Dermatol Clin 2012; 30:731-48, vii. [PMID: 23021056 DOI: 10.1016/j.det.2012.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A large number of foreign substances may penetrate the skin for both voluntary and involuntary reasons. The voluntary group includes the particulate materials used in tattoos and cosmetic fillers, whereas the involuntary group is almost always caused by accidental inclusion of external substances secondary to cutaneous trauma. This article focuses on the histopathologic findings seen in cutaneous reactions to exogenous agents, with special emphasis on the microscopic morphology of the external particles in recognizing specifically the involved substance (something that is becoming increasingly important in the event of litigation).
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avenida Reyes Católicos 2, Madrid 28040, Spain.
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Neves RD, Herdt MA, Wohlgemuth FB, Ely JB, de Vasconcellos ZAA, Bastos JCF, d'Acampora AJ. Possible migration and histopathological analysis of injections of polymethylmethacrylate in wistar rats. ISRN DERMATOLOGY 2012; 2012:609158. [PMID: 22701181 PMCID: PMC3369493 DOI: 10.5402/2012/609158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 02/16/2012] [Indexed: 11/23/2022]
Abstract
Objective. To evaluate the possible migration of polymethylmethacrylate after injections in various corporal compartments of Wistar rats. Methods. The experimental work consisted in the injection of PMMA in corporal compartments for later histopathological analysis of the locations of implants and of distant filtering organs. The dose applied in each implant was of 0.2 mL. The animals were divided into groups according to the location of the implant realized: group GB had intradermic injections in the glabella. Group SD had subdermal injections in dorsal subcutaneous tissue cells. Group IP had intraperitoneal injections in the abdomen. Group PD had intramuscular injections in the right rear leg. The rats were sacrificed 30 days after realization of the implants and tissue samples from the lung, liver, spleen, and kidney, and locations of implantation were removed for histopathological analysis. Results. Characteristic microspheres that were compatible with the presence of PMMA in any of the histological slides analyzed were not observed. One animal had an amorphous exogenous substance, with a histiocytic reaction. Twelve of the 16 lungs analyzed had locations of intraalveolar hemorrhaging. Two animals had nonspecific spleen alterations. Conclusion. The histopathological analysis of this study found no PMMA microspheres in any of the tissues analyzed.
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Affiliation(s)
- Rodrigo d'Eça Neves
- Department of Surgery, Federal University of Santa Catarina (UFSC), 88040-900 Florianópolis, SC, Brazil
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Traitement de la lipoatrophie faciale par lipofilling chez les patients infectés par le VIH : étude rétrospective de 317 patients sur neuf ans. ANN CHIR PLAST ESTH 2012; 57:210-6. [DOI: 10.1016/j.anplas.2011.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/27/2011] [Indexed: 11/27/2022]
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López-Pestaña A, Tuneu A, Lobo C, Zubizarreta J. [Sarcoid granulomas in facial cosmetic filler material: induction by interferon-α and ribavirin in a patient with hepatitis C]. ACTAS DERMO-SIFILIOGRAFICAS 2012; 102:746-7. [PMID: 21640959 DOI: 10.1016/j.ad.2011.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 01/17/2011] [Accepted: 01/23/2011] [Indexed: 11/28/2022] Open
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Sarcoid Granulomas in Facial Cosmetic Filler Material: Induction by Interferon-α and Ribavirin in a Patient with Hepatitis C. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sachdev M, Anantheswar Y, Ashok B, Hameed S, Pai SA. Facial granulomas secondary to injection of semi-permanent cosmetic dermal filler containing acrylic hydrogel particles. J Cutan Aesthet Surg 2011; 3:162-6. [PMID: 21430829 PMCID: PMC3047734 DOI: 10.4103/0974-2077.74493] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Various reports of long-term complications with semi-permanent fillers, appearing several years after injections have created some concern about their long-term safety profile. We report a case of foreign body granuloma secondary to dermal filler containing a copolymer of the acrylic hydrogel particles, hydroxyethylmethacrylate and ethylmethacrylate, occurring 2 years after the injection. The foreign body granulomas could not be treated satisfactorily with intralesional steroids, and the patient required a surgical excision of her granulomas. The physical and psychological consequences to such patients can be quite devastating.
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Affiliation(s)
- Mukta Sachdev
- Department of Dermatology, Manipal Hospital, Airport Road, Bangalore, India
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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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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Plaza T, Lautenschlager S. Penis swelling due to foreign body reaction after injection of silicone. J Dtsch Dermatol Ges 2010; 8:689-91. [PMID: 20337774 DOI: 10.1111/j.1610-0387.2010.07427.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 19-year-old man presented with phimosis and painful swelling of the penis four weeks after augmentation with silicone in Thailand. Histology revealed a foreign body reaction to silicone. Infectious causes were ruled out. Granulomatous foreign body reactions to silicone are common, but there are few case reports on reactions following silicone injection for penis enlargement. Foreign body reactions should be included in the differential diagnosis of penis swelling.
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Affiliation(s)
- Tobias Plaza
- Dermatology Office Dr. Tobias Plaza, Uster, Switzerland.
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Sage RJ, Chaffins ML, Kouba DJ. Granulomatous foreign body reaction to hyaluronic acid: report of a case after melolabial fold augmentation and review of management. Dermatol Surg 2009; 35 Suppl 2:1696-700. [PMID: 19807766 DOI: 10.1111/j.1524-4725.2009.01349.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Robert J Sage
- Henry Ford Health System, Detroit, Michigan 48202, USA
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Miro-Mur F, Hindié M, Kandhaya-Pillai R, Tobajas V, Schwartz S, Alijotas-Reig J. Medical-grade silicone induces release of proinflammatory cytokines in peripheral blood mononuclear cells without activating T cells. J Biomed Mater Res B Appl Biomater 2009; 90:510-20. [PMID: 19145631 DOI: 10.1002/jbm.b.31312] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For more than 40 years, silicone implants had been employed in aesthetic, cosmetic medicine, and plastic surgery. Although adverse reactions produced by these products are rare, cases of immuno-mediated reactions have been reported. To evaluate the aspects of immuno-reactivity to medical-grade silicone dermal filler, peripheral blood mononuclear cells (PBMC) of 39 individuals were studied. PBMC used include individuals with silicone injection-related delayed adverse reactions, with silicone injections, and healthy control. Silicone induced production of TNF-alpha and IL-6 in all three groups. Notably, elevated production of IL-6 was observed in nonstimulated PBMC and also the percentage of CD4(+)CD69(+) T cells was higher in PHA-stimulated PBMC from individuals with silicone injection-related adverse reactions when compared with other two groups. However, IFN-gamma was not released in silicone-stimulated or silicone+LPS-stimulated PBMC from any group and no production of IL-2 was measured indicating no proliferative response of PBMC. Subsequently, no CD4(+)CD69(+) T cells were observed in these conditions. Finally, the inflammatory response in silicone-stimulated cultures of monocyte-derived macrophages with autologous lymphocytes is lesser than that observed in PBMC. In conclusion, silicone induces a release of proinflammatory cytokines but does not act as a polyclonal activator of CD4(+) T cells. Thus, silicone is mounting an immune response in individuals with silicone-related adverse effects but is not silicone antigen-dependent.
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Affiliation(s)
- Francesc Miro-Mur
- Aging Basic Research Group, Molecular Biology and Biochemistry Research Center for Nanomedicine, CIBBIM-Nanomedicine, Vall Hebron University Hospital, Barcelona, Spain
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Pons-Guiraud A. Complications des produits de comblement injectables. Ann Dermatol Venereol 2009; 136 Suppl 6:S293-8. [DOI: 10.1016/s0151-9638(09)72536-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Andre P, Lowe NJ, Parc A, Clerici TH, Zimmermann U. Adverse reactions to dermal fillers: A review of European experiences. J COSMET LASER THER 2009; 7:171-6. [PMID: 16414905 DOI: 10.1080/14764170500344393] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Europe, numerous dermal fillers have been utilized for the past decade. A lot of drawbacks have been reported and sometimes, severe complications occurred. OBJECTIVE Our purpose is to report the clinical aspects of the adverse reactions following injections of some of the dermal fillers. Histological aspects of complications are also described. RESULTS Adverse reactions secondary to biodegradable products are usually time limited, but with the non-biodegradable products, we have observed severe, persistent, and recurrent complications. Histological examinations, in cases of non-biodegradable products, may show the presence and persistence of the filler. CONCLUSION For the moment, there is no ideal dermal filler. All fillers can lead to adverse events and we need to inform patients fully before injecting. Clinical studies with long-term follow-up before launching a new product on the market are recommended. We believe that in Europe, at present, the CE mark is not a guarantee of safety of dermal fillers.
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Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes. Plast Reconstr Surg 2009; 123:1842-1863. [DOI: 10.1097/prs.0b013e31818236d7] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reszko AE, Sadick NS, Magro CM, Farber J. Late-Onset Subcutaneous Nodules After Poly-l-Lactic Acid Injection. Dermatol Surg 2009; 35 Suppl 1:380-4. [DOI: 10.1111/j.1524-4725.2008.01042.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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