title: Late-onset granulomatous reaction to Artecoll.
abstract: BACKGROUND
  Artecoll is permanent filler that is used for the correction of facial wrinkles. It has been used mainly in Europe in the last 9 years. It is a suspension of 25% polymethylmethacrylate microspheres of 30 to 40 microns in diameter and 75% athecollagen.
  
  
  OBJECTIVE
  To report a side effect of a late-onset granulomatous reaction to Artecoll.
  
  
  METHODS
  We report the case of a 54-year-old woman who presented with longitudinal hard nodules with slight overlying erythema in the glabella and nasolabial folds 14 months after she was treated with Artecoll injections to her glabellar and nasolabial wrinkles. An excisional biopsy of a glabellar nodule was performed.
  
  
  RESULTS
  Microscopic examination of hematoxylin and eosin-stained specimen revealed histiocytic granulomas with giant cells and vacuoles, a picture of Artecoll granulomas. Treatment with topical steroids showed no improvement. Intralesional injections of Kenalog caused temporary disappearance of the granulomas. A few months later the nodules reappeared. No further treatment was done.
  
  
  CONCLUSIONS
  Artecoll injection to wrinkles of the face can cause delayed granulomatous reaction. This side effect is not reversible and should be addressed in the informed consent.
authors.affiliation: Mohs Surgery Unit, Assuta Medical Center, Tel-Aviv. alcalays@inter.-net.il
authors.forename: Joseph
authors.initials: J
authors.lastname: Alcalay
authors.forename: Ronen
authors.initials: R
authors.lastname: Alkalay
authors.forename: Andrea
authors.initials: A
authors.lastname: Gat
authors.forename: Shmuel
authors.initials: S
authors.lastname: Yorav
mesh_terms: D003094:Collagen / Q000009:adverse effects*; D005260:Female; D006099:Granuloma / Q000139:chemically induced*; D006801:Humans; D008863:Microspheres; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000009:adverse effects* / Q000031:analogs & derivatives*; D015595:Skin Aging / Q000187:drug effects*
chemical_list: C445359:Artecoll; D003094:Collagen; D019904:Polymethyl Methacrylate