Adverse Granulomatous Reaction to Silicone Filler Treated With Methotrexate

Pérez-Ruiz, C.; Barabash-Neila, Román; Zulueta‐Dorado, Teresa; Sánchez, Julián Conejo-Mir

doi:10.1097/00042728-900000000-98693

Cited by 2 publications

(3 citation statements)

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“…A case report of adverse granulomatous reaction to silicone filler treated with subcutaneous methotrexate 15 mg once weekly has been published recently by a Spanish team with complete regression of granulomas 3 months later. No new lesions had developed after 1 year of observation . This is, to our knowledge, the first case series describing the utility of methotrexate for treatment of GFBR to non‐biodegradable fillers.…”

Section: Discussionmentioning

confidence: 74%

“…Granulomatous foreign body reactions associated with fillers injections are rare with previous reported incidences in the range 0.02–2.8% . Such reactions are usually delayed (up to 20 years in the literature) and have been reported mainly with non‐biodegradable filling materials including PMMA microspheres, HEMA, LIS, polyacrylamide gel or polyalkylimide gel but remain unusual with hyaluronic acid (HA) . All injection sites may be involved, although perioral involvement is among the most frequently reported sites in the literature .…”

Section: Discussionmentioning

confidence: 99%

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Management of granulomatous foreign body reaction to fillers with methotrexate

Broly

Marie

Picard³

et al. 2019

Acad Dermatol Venereol

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Background Granulomatous foreign body reactions (GFBR) have been reported after injection with almost every soft tissue fillers, more commonly with non‐biodegradable ones. Such granulomatosis is rare but can cause significant discomfort owing to their aesthetic and functional repercussions. Objective To determine whether immunomodulation with low doses of methotrexate is effective in the treatment of GFBR to filler material. Methods Clinical case series of four patients with severe, treatment‐resistant GFBR to non‐biodegradable fillers in the Department of Dermatology of Bordeaux University Hospital, Bordeaux, France, successfully treated with oral or subcutaneous methotrexate, 10–15 mg weekly during 6 months. Adverse events were monitored throughout the treatment once weekly the first month then once monthly the remaining 5 months. Results Four women with a mean age of 73.7 years (66–85 years) and nodularity of the face were included and treated up to 6 months. Histological findings were consistent with GFBR to liquid injectable silicone in 2 cases, polymethylmethacrylate in 1 case and hydroxyethylmethacrylate in the last case. The delay after injection of the filler material was from 17 to 30 years. In one patient, inflammatory lesions followed dental care. After 6 months of treatment with 10–15 mg once weekly, all patients were cleared. Three patients developed a mild hepatic cytolysis (grade 1 or 2). Methotrexate could be maintained in those 3 cases and was discontinuated after 6 months in all cases. Two patients developed recurrence of lesions, 28 and 9 months, respectively, after treatment stops, requiring reintroduction of treatment. The two other patients remained cleared after 6 months of follow‐up. Conclusion Low doses of methotrexate appear to offer a low‐risk therapeutic alternative in resistant and severe GFBR to fillers. A prospective study with long‐term follow‐up is required to confirm these preliminary observations.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Management of granulomatous foreign body reaction to fillers with methotrexate

Broly

Marie

Picard³

et al. 2019

Acad Dermatol Venereol

View full text Add to dashboard Cite

show abstract

“…Treatment of adverse outcomes related to the injection of liquid silicone fillers can be challenging, ranging from surgical excision to medical management with anti-inflammatory and immunomodulatory agents, such as oral corticosteroids, allopurinol, colchicine, isotretinoin, cyclosporine, imiquimod, and antibiotics. 4 In patients who have not necessarily experienced adverse effects but nonetheless desire removal, options are even more limited, with surgical excision remaining the most common consideration. However, given scarring and other potential morbidity associated with surgical excision, many patients choose to defer removal and leave the silicone filler in place because of a lack of less invasive options.…”

mentioning

confidence: 99%