title: Association between bovine collagen dermal implants and a dermatomyositis or a polymyositis-like syndrome.
abstract: OBJECTIVE
  To determine whether an excess incidence of dermatomyositis or polymyositis or both exist in patients treated with injectable bovine collagen implants and to characterize the clinical picture.
  
  
  METHODS
  Historical cohort study (July 1980 through June 1988).
  
  
  METHODS
  Patients were identified from personal experience or adverse reaction reports received by the manufacturer.
  
  
  METHODS
  An 8-year period in the United States during which approximately 345,000 patients received implants.
  
  
  RESULTS
  Eight patients with dermatomyositis and an additional patient with polymyositis were identified from approximately 345,000 patients receiving injectable bovine collagen implants from July 1980 through June 1988. The nine patients with dermatomyositis or polymyositis were diagnosed an average of 6.4 months (range, 0.7 to 24.9 months) after collagen implant or skin test exposure or both. Eight of the nine patients had a delayed-type hypersensitivity response at the test or treatment sites or both, and five of six patients tested were found to have increased serum antibodies to collagen. Compared with the general population, the incidence of dermatomyositis or polymyositis among collagen-treated patients was statistically increased (standardized incidence ratio, 5.05; 95% CI, 2.31 to 9.59; P < 0.0001). A similar analysis of the eight dermatomyositis case patients produced a standardized incidence ratio of 18.8 (CI, 8.1 to 37.0; P < 0.0001). Using a Monte Carlo simulation, an interval of 6.4 months or less from exposure to onset of disease was found to be an extremely rare event, occurring less than 72 times per one million simulation trials (CI, 57 to 91).
  
  
  CONCLUSIONS
  Because these data suggest that an immunologic response to bovine type I or type III collagen or both caused this dermatomyositis or polymyositis-like syndrome, the risks versus benefits for the cosmetic use of collagen implants should be reassessed.
authors.affiliation: Baylor College of Medicine, Department of Plastic Surgery, Houston, TX 77030.
authors.forename: J
authors.initials: J
authors.lastname: Cukier
authors.forename: R A
authors.initials: RA
authors.lastname: Beauchamp
authors.forename: J S
authors.initials: JS
authors.lastname: Spindler
authors.forename: S
authors.initials: S
authors.lastname: Spindler
authors.forename: C
authors.initials: C
authors.lastname: Lorenzo
authors.forename: D E
authors.initials: DE
authors.lastname: Trentham
mesh_terms: D000328:Adult; D000818:Animals; D000906:Antibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000209:etiology; D002417:Cattle; D015331:Cohort Studies; D003094:Collagen / Q000009:adverse effects* / Q000276:immunology; D003882:Dermatomyositis / Q000209:etiology*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D017285:Polymyositis / Q000209:etiology*; D019736:Prostheses and Implants / Q000009:adverse effects*; D013577:Syndrome
chemical_list: D000906:Antibodies; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen