Scar sarcoidosis after hyaluronic acid injection

Abstract

A 54-year-old woman presented with a 5-month history of tender nodules in both nasolabial folds that had developed 4 months after the injection of hyaluronic acid (HA) (Restylane) for wrinkles. The patient was treated with 1.5 mg/day betamethasone for 6 days and her lesions disappeared within 1 week. About 8 days after stopping therapy, however, new nodules developed at the same site, on previously healthy buttocks, and on old scars. On examination, nodules of about 0.5-1 cm in size were palpable at the nasolabial folds, and red nodules were present on the buttocks (Fig. 1) and on two old scars. Laboratory tests disclosed an increased protein C reaction (7.9 mg/L; normal value, < 5 mg/L) and acetyl-converting enzyme test (14.5 U/L; normal value, < 9 U/L). A chest X-ray was normal. Lung function tests showed a decreased lung CO diffusion, and chest axial tomography disclosed fibrosis, increased parenchyma density, and calcifications, findings suggestive of a diagnosis of lung sarcoidosis. An X-ray of the hands showed some bone cysts. Interestingly, two granulomatous lesions were observed at the sites of venipuncture. Histology of a gluteal lesion biopsy showed a deep granuloma with epithelioid and Langhans cells in the absence of necrobiosis. Sarcoidosis was diagnosed and the patient was given 50 mg/day prednisone with clear clinical improvement of cutaneous lesions in about 6 months. Decreased parenchyma density was also observed by chest axial tomography.

Delayed Immune-Mediated Adverse Effects of Polyalkylimide Dermal Fillers

“…Others have reported similar results for other granulomatous immunemediated diseases such as sarcoidosis and sarcoidosisrelated disorders 26 and sarcoidosis related to implant fillers. [27][28][29] Interestingly, plasma ACE values remained elevated in 4 of our patients (patients 3, 5, 9, and 19).…”

Scar sarcoidosis

“…Eski yaraların in ltrasyonu ya da bu bölgelerde yeni gelişen küçük kırmızı-kahverengi nodüller şeklinde karşımıza çıkabilmektedir. Eski skar alanlarının neden etkilendiği henüz tam olarak aydınlatılamamakla birlikte genetik olarak yatkınlığı olan bireylerde sarkoidozda aktive olmuş T hücre aracılı immün yanıtın travma ile ilişkili olarak dokuyu persiste eden yabancı cisme karşı yönelmesi sonucu skar sarkoidozunun gelişebildiği ya da paterji reaksiyonunun özel bir formu olabileceği bildirilmiştir 8,9 . Skar sarkoidozu ile sistemik hastalık aktivitesi arasında paralellik olduğu düşünülmektedir.…”

Lip Nodules Caused by Hyaluronic Acid Filler Injection: Report of Three Cases

“…This may result from reactivity of some patients to the protein residues of bacterial or avian origin, or impurities from the cross-linking process [19]. Uncommon non-allergic adverse reactions include bacterial infection, aseptic or cold abscess, herpes reactivation [29], generalized scleromyxedema [30], scar sarcoidosis [31], interferon-induced systemic sarcoidosis in patients with chronic hepatitis C [32], and necrosis and livedoid pattern due to accidental arterial embolization [33]. Migration of the filler into a tunnel or track created by a large needle or cannula may manifest as a single and well-defined nodule 1-2 months after injection and may persist until resorption [34,35].…”