JEADV
DOI: 10.1111/jdv.12522
SHORT REPORT
Adverse reaction to silicone simulating orofacial granulomatosis n,1 O. Sanmartın1 C. Requena,1,* L. Requena,2 V Alegre,3 C. Serra,1 B. Llombart,1 E. Nagore,1 C. Guille Department of Dermatology, Instituto Valenciano de Oncologıa, Valencia, n Jime nez Dıaz, Madrid, Department of Dermatology, Fundacio 3 Department of Dermatology, Consorcio Hospital General Universitario, Valencia, Spain *Correspondence: C Requena. E-mail: [email protected] 1 2
Abstract Background Granulomatous reactions to silicone facial fillers are well described in the literature. Clinically, these reactions present as nodules or pseudotumors that are frequently described as silicone granulomas or siliconomas. Objective We want to report a peculiar form of granulomatous reaction to injected silicone characterized by recurrent episodes of facial edema. Methods We collected silicone infiltrated patients with a similar clinical picture consisting of asymptomatic episodes of unilateral facial edema that had been recurring for months or years. Results We found four women with recurrent episodes of facial edema. They had been infiltrated with silicone in the face. Histology showed silicone deposits and a granulomatous infiltrate in all 4 cases. Conclusion We describe and illustrate a new type of adverse reaction to injected silicone simulating orofacial granulomatosis. The reaction presents as recurrent, unilateral, asymmetric facial edema of the cheek in patients who have been injected with silicone in the face. Familiarity with this adverse reaction will help to prevent erroneous diagnoses such as idiopathic angioedema, Melkersson Rosenthal syndrome, and orofacial granulomatosis. Received: 21 February 2014; Accepted: 17 March 2014
Conflicts of interest None declared.
Funding sources There is not any funding source that supported the work.
Introduction
Case 1
Many new cosmetic fillers, or microimplants, have emerged in the fields of plastic surgery and dermatology. Nevertheless, silicone fillers, which have been in use for decades, are still widely used and are in fact the most studied of all cosmetic fillers.1 Pure medicalgrade silicone used in small amounts for soft tissue augmentation causes relatively few adverse effects considering its widespread use. Granulomatous reactions to injected silicone are well described in the literature,2–7 and in some cases, undesirable granulomatous reactions to small amounts of this filler are due to inadequate injection in the papillary dermis. We report four cases of a previously undescribed granulomatous reaction to injected silicone in the deep dermis and/or hypodermis that simulated orofacial granulomatosis. Orofacial granulomatosis is a chronic disorder characterized by intermittent diffuse enlargement of the lips or facial swelling, which eventually become persistent.
A 65-year-old woman consulted for recurrent episodes of facial oedema involving the left cheek (Fig. 1). The swelling had occurred two or three times a month for the previous 3 years, with each episode lasting up to a week. The patient had been treated repeatedly with oral methylprednisolone and had developed Cushing syndrome. Her medical history showed diabetes mellitus and hypercholesterolemia. She did not have fissured tongue or facial paralysis. She reported having been injected with a filler agent – Dermalive according to her cosmetic doctor – 13 years earlier. A biopsy showed diffuse interstitial vacuoles and cystic spaces of different sizes located between the dermal collagen bundles and in the hypodermis. The vacuoles were surrounded by some macrophages, several of which had foamy cytoplasm (Fig. 2). Some of the foamy deposits were
JEADV 2014
© 2014 European Academy of Dermatology and Venereology
Requena et al.
2
Figure 1 Patient 1. Obvious oedema and induration of the left cheek.
located between bands of striated muscle. The foreign material did not exhibit birefringence under polarized light microscopy. Treatment was started with allopurinol 100 mg twice a day for 2 months and three times a day thereafter. The patient also required oral prednisone for 3 to 5 days at least once a month over the following 9 months. Following this period, the patient continued to receive allopurinol 100 mg twice daily, leading to resolution of Cushing syndrome.
Case 2 The second patient was a 72-year-old woman who had had obvious oedema of the right cheek for the past fortnight (Fig. 3). She reported two similar episodes some years ago, but they had been milder and had improved spontaneously. On physical examina-
(a)
(c)
JEADV 2014
tion, the tongue was not fissured and there was no facial paralysis. Furthermore, the patient did not recall having ever noticed facial paralysis. The facial oedema was due to a deep solid palpable nodule located in the lower part of the right cheek. The right nasolabial fold was obliterated by the swelling. The patient reported that she had received cosmetic filler injections 15 years earlier. A biopsy showed a mild deep dermal and hypodermal diffuse granulomatous infiltrate packed with spherical clear globules of different sizes. Some multinucleated giant cells and histiocytes with tiny vacuoles in the cytoplasm were observed. These larger vacuoles were seen as extracellular deposits. Some of the foamy deposits were located between bands of striated muscle. The foreign material did not exhibit birefringence under polarized light microscopy. Treatment was started with oral prednisone for 9 days and the oedema improved. The nodule in the deep right cheek was still palpable, but it was not a problem for the patient because she was used to it. She experienced no more episodes of facial oedema in a year of observation.
Case 3 A 68-year-old woman consulted for episodes of asymptomatic oedema affecting the right cheek during the previous year. She had been diagnosed with idiopathic angio-oedema and had been treated with several courses of oral corticosteroids. She did not have fissured tongue or facial paralysis, and her past medical history was not significant. When asked if she had been injected with a cosmetic filler, she said that she had received injections 3 years earlier, but was not sure of the material employed. A biopsy showed the whole dermis to be filled with multiple
(b)
(d)
Figure 2 Patient 1. (a) Diffuse interstitial vacuoles and cystic spaces of different sizes with an inflammatory infiltrate localized between dermal collagen bundles and in the hypodermis (haematoxylin–eosin, original magnification 940). (b) Some of the vacuoles are between bands of striated muscle (original magnification 9100). (c) Empty vacuoles are surrounded by a few lymphocytes and macrophages (original magnification 9200). (d) Macrophages with foamy cytoplasms (original magnification 9400).
© 2014 European Academy of Dermatology and Venereology
Siliconoma mimicking orofacial granulomatosis
3
spherical globules of different sizes with a mild granulomatous infiltrate composed of lymphocytes and histiocytes. The larger vacuoles were seen as extracellular deposits. Some of the foamy deposits were located between bands of striated muscle and the foreign material did not exhibit birefringence under polarized light microscopy.
Discussion
Figure 3 Patient 2. Obvious oedema and induration of the right cheek, obliterating the nasolabial fold.
Figure 4 Patient 4. Oedema of the left cheek has erased the left nasolabial fold. Erythema of the skin is observed.
round, empty, sharply circumscribed and non-birefringent vacuoles of varying sizes embedded within thickened bundles of collagen. This material was surrounded by a mild inflammatory infiltrate of lymphocytes and histiocytes. The smaller vacuoles were intracellular and the larger ones were extracellular. She began treatment with clofazimine 50 mg a day for the first month, followed by 100 mg a day for a year. She improved during this time, but experienced a relapse when treatment was stopped.
Case 4 A 75-year-old otherwise healthy woman consulted for recurrent episodes of facial oedema for the last 4 years. The oedema always affected the left cheek and was invariably resolved after 1 or 2 weeks of oral corticosteroid therapy. Magnetic resonance imaging showed an asymptomatic left frontal meningioma measuring 10 mm. Physical examination showed indurated left facial oedema and erased the left nasolabial fold (Fig. 4). She had no facial paralysis or any recollection of ever having had it. She also did not have fissured tongue. She reported having received collagen injections in her cheeks 5 years earlier. Biopsy showed the deep dermis and hypodermis to be packed with clear
JEADV 2014
There are three forms of silicone in medical use: oil (Silikon 1000, Fort Worth, TX, USA; Silskin, Peabody, MA, USA), gel (MDX 4-4011, Midland, MI, USA; Dow Corning, Midland, MI, USA) and elastomer (Silastic, Midland, MI, USA). Liquid and gel injectable silicone have been widely used for the correction of small wrinkles or scars on the face. While many adverse effects have been described, not all these have been clearly linked to the silicone itself. Many alleged reactions to silicone might actually be reactions to impurities in non-medical-grade silicone. Pure medical-grade silicone appears to be relatively safe when used in small amounts for soft tissue augmentation,8 but granulomatous reactions to cosmetic silicone injections in the dermis or hypodermis are well described in the literature.2–7 These reactions are usually reported as pseudotumoural lesions, inflammatory nodules, also named ‘siliconomas’ and appear many years after injection. Based on reports in the literature, the nodules appear to remain quite stable over time. However, this was not the case with our four patients, all of whom experienced recurrent episodes of facial oedema above the silicone nodules. We do not know why the nodules in our patients were accompanied by recurrent inflammatory episodes, but one explanation might be idiosyncratic factors. None of the patients, however, had a history of inflammatory disease. Familiarity with facial oedema associated with cosmetic silicone injections is important as, based on our experience, this adverse effect is not uncommon and could easily be mistaken for angio-oedema, Melkersson–Rosenthal syndrome, or orofacial granulomatosis. Our third patient had been erroneously diagnosed with idiopathic angio-oedema. She had not told her doctor that she had been injected with fillers because she did not think that it was the origin of the swelling. The histological appearance of granulomatous reactions to silicone varies according to the form of silicone used. In the case of solid elastomer silicone, the granulomatous infiltrate is more prominent and rich in multinucleated giant cells,9 whereas in the case of oil and gel silicone, the inflammatory response is milder and silicone vacuoles appear as interstitial vacuoles and empty cystic spaces of different sizes between collagen bundles, sometimes with a foamy appearance.10 This histopathological pattern, known as the Swiss cheese-like pattern, would also appear to be a feature of the clinical presentation described in our series: siliconoma with recurrent facial oedema. We did not detect any differences between the histological features observed in our patients and previously described features of classical
© 2014 European Academy of Dermatology and Venereology
Requena et al.
4
granulomatous reactions to silicone, and can therefore assume that our patients experienced a form of silicone-induced angiooedema, without histopathological expression. Familiarity with the histological features of injected silicone in the skin is crucial. Had we not recognized these features in our patients, we might easily have made an incorrect diagnosis of Melkersson–Rosenthal syndrome or orofacial granulomatosis. Investigation of a history of filler injections is also important, as illustrated by each of our cases. Silicone vacuoles are generally easy to recognize histologically but this is not always so. In fact, there have been reports of granulomatous reactions to silicone with histological features simulating well-differentiated liposarcoma.11,12 The histological appearance of the injected material can also be useful to identify the filler used, as occurred in patients 1 and 4 in our series. They thought that they had been injected with Dermalive and collagen, respectively, but they had actually both been injected with silicone. Histological identification of filler agents employed could have medicolegal implications, e.g. in investigations of the use of adulterated or inadequate fillers.13 The treatment of the adverse reactions to injected silicone is not always successful. We used oral corticosteroids, which provided temporary improvement, in addition to allopurinol and clofazimine to reduce oral corticosteroid use in two cases. Other treatment options, used in conventional siliconomas, include minocycline14 and intralesional injections of corticosteroids.15 We have described four cases of a new adverse reaction to cosmetic silicone injections simulating orofacial granulomatosis. The reaction consisted of recurrent unilateral, asymmetric facial oedema. Diagnosis can be difficult because the facial oedema may not appear until many years after the silicone injection, making it difficult to establish the link. Familiarity with this potential adverse reaction to cosmetic silicone – and confirmation by biopsy – will aid diagnosis.
JEADV 2014
References 1 Duffy D. Silicone. A critical review. Adv Dermatol 1990; 5: 93–109. 2 Winer LH, Sternberg TH, Lehman R, Ashley FL. Tissue reactions to injected silicone liquids. Arch Dermatol 1964; 90: 588–593. 3 Achauer BM. A serious complication following medical-grade silicone injection of the face. Plast Reconstr Surg 1983; 71: 251–253. 4 Pearl RM, Laub DR, Kaplan EN. Complications following silicone injections for augmentation of the contour of the face. Plast Reconstr Surg 1983; 71: 251–253. 5 Pimentel L, Barnadas M, Vidal D, Sancho F, Fontarnau R, Alomar A. Simultaneous presentation of silicone and silica granuloma. Dermatology 2002; 205: 162–165. 6 Wilkie TF. Late development of granuloma after liquid silicone injections. Plast Reconstr Surg 1977; 60: 179–188. 7 Yanagihara M, Fujii T, Wakamatu N et al. Silicone granuloma on the entry points of acupuncture, venepuncture and surgical needles. J Cutan Pathol 2000; 27: 301–305. 8 Morgan AM. Localized reactions to injected therapeutic materials. Part 2. Surgical agents. J Cutan Pathol 1995; 22: 289–303. 9 Requena L, Requena C, Christensen L, Zimmermann US, Kutzner H, Cerroni L. Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64: 1–34. 10 Krayenb€ uhl BH, Panizzon RG. Silicone granuloma. Dermatology 2000; 200: 360–362. 11 Mustacchio V, Cabibi D, Minervini MI, Barresi E, Amato S. A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes. J Cutan Pathol 2007; 34: 281–283. 12 Maly A, Regev E, Meir K, Maly B. Tissue reaction to liquid silicone simulating low-grade liposarcoma following lip augmentation. J Oral Pathol Med 2004; 33: 314. 13 Requena C, Izquierdo MJ, Navarro M et al. Adverse reactions to injectable aesthetic microimplants. Am J Dermatopathol 2001; 23: 197–202. 14 Senet P, Bachelet H, Ollivaud L, Vignon-Pennamen D, Dubertret L. Minocycline for the treatment of cutaneous silicone granulomas. Br J Dermatol 1999; 140: 985–987. 15 Bigata X, Ribera M, Bielsa I, Ferrandiz C. Adverse granulomatous reaction after cosmetic dermal silicone injection. Dermatol Surg 2001; 27: 198–200.
© 2014 European Academy of Dermatology and Venereology
DOI: 10.1111/jdv.12522
SHORT REPORT
Adverse reaction to silicone simulating orofacial granulomatosis n,1 O. Sanmartın1 C. Requena,1,* L. Requena,2 V Alegre,3 C. Serra,1 B. Llombart,1 E. Nagore,1 C. Guille Department of Dermatology, Instituto Valenciano de Oncologıa, Valencia, n Jime nez Dıaz, Madrid, Department of Dermatology, Fundacio 3 Department of Dermatology, Consorcio Hospital General Universitario, Valencia, Spain *Correspondence: C Requena. E-mail: [email protected] 1 2
Abstract Background Granulomatous reactions to silicone facial fillers are well described in the literature. Clinically, these reactions present as nodules or pseudotumors that are frequently described as silicone granulomas or siliconomas. Objective We want to report a peculiar form of granulomatous reaction to injected silicone characterized by recurrent episodes of facial edema. Methods We collected silicone infiltrated patients with a similar clinical picture consisting of asymptomatic episodes of unilateral facial edema that had been recurring for months or years. Results We found four women with recurrent episodes of facial edema. They had been infiltrated with silicone in the face. Histology showed silicone deposits and a granulomatous infiltrate in all 4 cases. Conclusion We describe and illustrate a new type of adverse reaction to injected silicone simulating orofacial granulomatosis. The reaction presents as recurrent, unilateral, asymmetric facial edema of the cheek in patients who have been injected with silicone in the face. Familiarity with this adverse reaction will help to prevent erroneous diagnoses such as idiopathic angioedema, Melkersson Rosenthal syndrome, and orofacial granulomatosis. Received: 21 February 2014; Accepted: 17 March 2014
Conflicts of interest None declared.
Funding sources There is not any funding source that supported the work.
Introduction
Case 1
Many new cosmetic fillers, or microimplants, have emerged in the fields of plastic surgery and dermatology. Nevertheless, silicone fillers, which have been in use for decades, are still widely used and are in fact the most studied of all cosmetic fillers.1 Pure medicalgrade silicone used in small amounts for soft tissue augmentation causes relatively few adverse effects considering its widespread use. Granulomatous reactions to injected silicone are well described in the literature,2–7 and in some cases, undesirable granulomatous reactions to small amounts of this filler are due to inadequate injection in the papillary dermis. We report four cases of a previously undescribed granulomatous reaction to injected silicone in the deep dermis and/or hypodermis that simulated orofacial granulomatosis. Orofacial granulomatosis is a chronic disorder characterized by intermittent diffuse enlargement of the lips or facial swelling, which eventually become persistent.
A 65-year-old woman consulted for recurrent episodes of facial oedema involving the left cheek (Fig. 1). The swelling had occurred two or three times a month for the previous 3 years, with each episode lasting up to a week. The patient had been treated repeatedly with oral methylprednisolone and had developed Cushing syndrome. Her medical history showed diabetes mellitus and hypercholesterolemia. She did not have fissured tongue or facial paralysis. She reported having been injected with a filler agent – Dermalive according to her cosmetic doctor – 13 years earlier. A biopsy showed diffuse interstitial vacuoles and cystic spaces of different sizes located between the dermal collagen bundles and in the hypodermis. The vacuoles were surrounded by some macrophages, several of which had foamy cytoplasm (Fig. 2). Some of the foamy deposits were
JEADV 2014
© 2014 European Academy of Dermatology and Venereology
Requena et al.
2
Figure 1 Patient 1. Obvious oedema and induration of the left cheek.
located between bands of striated muscle. The foreign material did not exhibit birefringence under polarized light microscopy. Treatment was started with allopurinol 100 mg twice a day for 2 months and three times a day thereafter. The patient also required oral prednisone for 3 to 5 days at least once a month over the following 9 months. Following this period, the patient continued to receive allopurinol 100 mg twice daily, leading to resolution of Cushing syndrome.
Case 2 The second patient was a 72-year-old woman who had had obvious oedema of the right cheek for the past fortnight (Fig. 3). She reported two similar episodes some years ago, but they had been milder and had improved spontaneously. On physical examina-
(a)
(c)
JEADV 2014
tion, the tongue was not fissured and there was no facial paralysis. Furthermore, the patient did not recall having ever noticed facial paralysis. The facial oedema was due to a deep solid palpable nodule located in the lower part of the right cheek. The right nasolabial fold was obliterated by the swelling. The patient reported that she had received cosmetic filler injections 15 years earlier. A biopsy showed a mild deep dermal and hypodermal diffuse granulomatous infiltrate packed with spherical clear globules of different sizes. Some multinucleated giant cells and histiocytes with tiny vacuoles in the cytoplasm were observed. These larger vacuoles were seen as extracellular deposits. Some of the foamy deposits were located between bands of striated muscle. The foreign material did not exhibit birefringence under polarized light microscopy. Treatment was started with oral prednisone for 9 days and the oedema improved. The nodule in the deep right cheek was still palpable, but it was not a problem for the patient because she was used to it. She experienced no more episodes of facial oedema in a year of observation.
Case 3 A 68-year-old woman consulted for episodes of asymptomatic oedema affecting the right cheek during the previous year. She had been diagnosed with idiopathic angio-oedema and had been treated with several courses of oral corticosteroids. She did not have fissured tongue or facial paralysis, and her past medical history was not significant. When asked if she had been injected with a cosmetic filler, she said that she had received injections 3 years earlier, but was not sure of the material employed. A biopsy showed the whole dermis to be filled with multiple
(b)
(d)
Figure 2 Patient 1. (a) Diffuse interstitial vacuoles and cystic spaces of different sizes with an inflammatory infiltrate localized between dermal collagen bundles and in the hypodermis (haematoxylin–eosin, original magnification 940). (b) Some of the vacuoles are between bands of striated muscle (original magnification 9100). (c) Empty vacuoles are surrounded by a few lymphocytes and macrophages (original magnification 9200). (d) Macrophages with foamy cytoplasms (original magnification 9400).
© 2014 European Academy of Dermatology and Venereology
Siliconoma mimicking orofacial granulomatosis
3
spherical globules of different sizes with a mild granulomatous infiltrate composed of lymphocytes and histiocytes. The larger vacuoles were seen as extracellular deposits. Some of the foamy deposits were located between bands of striated muscle and the foreign material did not exhibit birefringence under polarized light microscopy.
Discussion
Figure 3 Patient 2. Obvious oedema and induration of the right cheek, obliterating the nasolabial fold.
Figure 4 Patient 4. Oedema of the left cheek has erased the left nasolabial fold. Erythema of the skin is observed.
round, empty, sharply circumscribed and non-birefringent vacuoles of varying sizes embedded within thickened bundles of collagen. This material was surrounded by a mild inflammatory infiltrate of lymphocytes and histiocytes. The smaller vacuoles were intracellular and the larger ones were extracellular. She began treatment with clofazimine 50 mg a day for the first month, followed by 100 mg a day for a year. She improved during this time, but experienced a relapse when treatment was stopped.
Case 4 A 75-year-old otherwise healthy woman consulted for recurrent episodes of facial oedema for the last 4 years. The oedema always affected the left cheek and was invariably resolved after 1 or 2 weeks of oral corticosteroid therapy. Magnetic resonance imaging showed an asymptomatic left frontal meningioma measuring 10 mm. Physical examination showed indurated left facial oedema and erased the left nasolabial fold (Fig. 4). She had no facial paralysis or any recollection of ever having had it. She also did not have fissured tongue. She reported having received collagen injections in her cheeks 5 years earlier. Biopsy showed the deep dermis and hypodermis to be packed with clear
JEADV 2014
There are three forms of silicone in medical use: oil (Silikon 1000, Fort Worth, TX, USA; Silskin, Peabody, MA, USA), gel (MDX 4-4011, Midland, MI, USA; Dow Corning, Midland, MI, USA) and elastomer (Silastic, Midland, MI, USA). Liquid and gel injectable silicone have been widely used for the correction of small wrinkles or scars on the face. While many adverse effects have been described, not all these have been clearly linked to the silicone itself. Many alleged reactions to silicone might actually be reactions to impurities in non-medical-grade silicone. Pure medical-grade silicone appears to be relatively safe when used in small amounts for soft tissue augmentation,8 but granulomatous reactions to cosmetic silicone injections in the dermis or hypodermis are well described in the literature.2–7 These reactions are usually reported as pseudotumoural lesions, inflammatory nodules, also named ‘siliconomas’ and appear many years after injection. Based on reports in the literature, the nodules appear to remain quite stable over time. However, this was not the case with our four patients, all of whom experienced recurrent episodes of facial oedema above the silicone nodules. We do not know why the nodules in our patients were accompanied by recurrent inflammatory episodes, but one explanation might be idiosyncratic factors. None of the patients, however, had a history of inflammatory disease. Familiarity with facial oedema associated with cosmetic silicone injections is important as, based on our experience, this adverse effect is not uncommon and could easily be mistaken for angio-oedema, Melkersson–Rosenthal syndrome, or orofacial granulomatosis. Our third patient had been erroneously diagnosed with idiopathic angio-oedema. She had not told her doctor that she had been injected with fillers because she did not think that it was the origin of the swelling. The histological appearance of granulomatous reactions to silicone varies according to the form of silicone used. In the case of solid elastomer silicone, the granulomatous infiltrate is more prominent and rich in multinucleated giant cells,9 whereas in the case of oil and gel silicone, the inflammatory response is milder and silicone vacuoles appear as interstitial vacuoles and empty cystic spaces of different sizes between collagen bundles, sometimes with a foamy appearance.10 This histopathological pattern, known as the Swiss cheese-like pattern, would also appear to be a feature of the clinical presentation described in our series: siliconoma with recurrent facial oedema. We did not detect any differences between the histological features observed in our patients and previously described features of classical
© 2014 European Academy of Dermatology and Venereology
Requena et al.
4
granulomatous reactions to silicone, and can therefore assume that our patients experienced a form of silicone-induced angiooedema, without histopathological expression. Familiarity with the histological features of injected silicone in the skin is crucial. Had we not recognized these features in our patients, we might easily have made an incorrect diagnosis of Melkersson–Rosenthal syndrome or orofacial granulomatosis. Investigation of a history of filler injections is also important, as illustrated by each of our cases. Silicone vacuoles are generally easy to recognize histologically but this is not always so. In fact, there have been reports of granulomatous reactions to silicone with histological features simulating well-differentiated liposarcoma.11,12 The histological appearance of the injected material can also be useful to identify the filler used, as occurred in patients 1 and 4 in our series. They thought that they had been injected with Dermalive and collagen, respectively, but they had actually both been injected with silicone. Histological identification of filler agents employed could have medicolegal implications, e.g. in investigations of the use of adulterated or inadequate fillers.13 The treatment of the adverse reactions to injected silicone is not always successful. We used oral corticosteroids, which provided temporary improvement, in addition to allopurinol and clofazimine to reduce oral corticosteroid use in two cases. Other treatment options, used in conventional siliconomas, include minocycline14 and intralesional injections of corticosteroids.15 We have described four cases of a new adverse reaction to cosmetic silicone injections simulating orofacial granulomatosis. The reaction consisted of recurrent unilateral, asymmetric facial oedema. Diagnosis can be difficult because the facial oedema may not appear until many years after the silicone injection, making it difficult to establish the link. Familiarity with this potential adverse reaction to cosmetic silicone – and confirmation by biopsy – will aid diagnosis.
JEADV 2014
References 1 Duffy D. Silicone. A critical review. Adv Dermatol 1990; 5: 93–109. 2 Winer LH, Sternberg TH, Lehman R, Ashley FL. Tissue reactions to injected silicone liquids. Arch Dermatol 1964; 90: 588–593. 3 Achauer BM. A serious complication following medical-grade silicone injection of the face. Plast Reconstr Surg 1983; 71: 251–253. 4 Pearl RM, Laub DR, Kaplan EN. Complications following silicone injections for augmentation of the contour of the face. Plast Reconstr Surg 1983; 71: 251–253. 5 Pimentel L, Barnadas M, Vidal D, Sancho F, Fontarnau R, Alomar A. Simultaneous presentation of silicone and silica granuloma. Dermatology 2002; 205: 162–165. 6 Wilkie TF. Late development of granuloma after liquid silicone injections. Plast Reconstr Surg 1977; 60: 179–188. 7 Yanagihara M, Fujii T, Wakamatu N et al. Silicone granuloma on the entry points of acupuncture, venepuncture and surgical needles. J Cutan Pathol 2000; 27: 301–305. 8 Morgan AM. Localized reactions to injected therapeutic materials. Part 2. Surgical agents. J Cutan Pathol 1995; 22: 289–303. 9 Requena L, Requena C, Christensen L, Zimmermann US, Kutzner H, Cerroni L. Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64: 1–34. 10 Krayenb€ uhl BH, Panizzon RG. Silicone granuloma. Dermatology 2000; 200: 360–362. 11 Mustacchio V, Cabibi D, Minervini MI, Barresi E, Amato S. A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes. J Cutan Pathol 2007; 34: 281–283. 12 Maly A, Regev E, Meir K, Maly B. Tissue reaction to liquid silicone simulating low-grade liposarcoma following lip augmentation. J Oral Pathol Med 2004; 33: 314. 13 Requena C, Izquierdo MJ, Navarro M et al. Adverse reactions to injectable aesthetic microimplants. Am J Dermatopathol 2001; 23: 197–202. 14 Senet P, Bachelet H, Ollivaud L, Vignon-Pennamen D, Dubertret L. Minocycline for the treatment of cutaneous silicone granulomas. Br J Dermatol 1999; 140: 985–987. 15 Bigata X, Ribera M, Bielsa I, Ferrandiz C. Adverse granulomatous reaction after cosmetic dermal silicone injection. Dermatol Surg 2001; 27: 198–200.
© 2014 European Academy of Dermatology and Venereology
