Treatment Site Reactions to Zyderm Collagen Implantation

Abstract

Two cases of treatment site granulomatous reaction to Zyderm Collagen Implant that occurred in spite of a negative skin test are reported. A delayed hypersensitivity reaction to ZCI is suggested by the clinical time course and the histologic findings of hypersensitivity granulomas. Humoral immunity is also implicated in the reaction since elevated anti-Zyderm serum antibodies and plasma cell infiltrates are present. Resolution of the clinical signs and symptoms occurred over several months with no treatment. The physician using ZCI should be aware of this rare adverse reaction.

A Randomized, Double‐Blind, Placebo‐Controlled Study to Determine the Safety and Efficacy of Cultured and Expanded Autologous Fibroblast Injections for the Treatment of Interdental Papillary Insufficiency Associated With the Papilla Priming Procedure

“…The approved dermal fillers, such as bovine collagen and cross‐linked human collagen, are acellular and resorb within 3 to 6 months 38,39 . In addition, 1% to 6% of patients receiving bovine collagen injections develop a localized hypersensitivity reaction 40,41 . Synthetic dermal fillers, such as silicone, have not been approved in the United States.…”

Adverse Reactions to Bovine Collagen Implant: Clinica1 and Histologic Features

“…Some patients may request treatment for temporary symptomatic relief, but this is by no means required for resolution of the reaction 7,19 . Antihistamines have been used for this purpose, but they are of uncertain value.…”

“…The histologic profile of these localized lesions has not been as well characterized. The reports that have been devoted exclusively to microscopic evaluation of reactions at ZCI test and treatment sites generally classify the responses as necrobiotic granulomas or palisading foreign body granulomas 5–8 . A smaller number of granulomas were formed by admixtures of inflammatory cells that were diffusely distributed 8 …”

Immunity to Injectable Collagen and Autoimmune Disease: A Summary of Current Understanding

“…These reactions consist of localized, implant‐associated erythema and induration, and may or may not be associated with pruritus 3,4,7 . The ZCI lesion has been described in a number of cases as a foreign‐body granuloma 8–10 or as a necrobiotic granuloma 11 . In these reports, the inflammatory cells usually surround the implant in a palisading fashion and consist of variable numbers of macrophages, lymphocytes, plasma cells, eosinophils, neutrophils, and giant cells.…”