title: Successful treatment of granulomatous reactions secondary to injection of esthetic implants.
abstract: BACKGROUND
  In recent years, various injectable materials have come into use to improve esthetic appearance.
  
  
  OBJECTIVE
  We describe the clinical and histopathologic aspects of two patients who received intradermal injections of an unknown dermal filler and the different diagnostic tools used to identify the unknown injected material (reflexion electron microscopy, electron dispersing x-ray) and discuss the possibility of a metastatic granulomatous reaction in one patient. We also describe two treatments for this complication and evaluate the legal considerations of the use of materials that have been adulterated and/or whose composition is unknown to the patient.
  
  
  METHODS
  We present two patients who developed a granulomatous foreign-body reaction after the subcutaneous injection of an esthetic implant. We treated patient 1 with isotretinoin and 2 months later with doxycycline. We administered isotretinoin to patient 2.
  
  
  RESULTS
  We observed a partial improvement in patient 1 after isotretinoin treatment and a remarkable improvement after administration of doxycycline. In patient 2, we observed an excellent response to isotretinoin.
  
  
  CONCLUSIONS
  Isotretinoin and doxycycline, when administered separately, seem to offer effective treatment for reactions resulting from silicone implants. However, further studies that include a larger number of patients and those with reactions secondary to other fillers are clearly needed before the effectiveness of this treatment can be confirmed.
authors.affiliation: Department of Dermatology, University Clinic of Navarra, Pamplona, Spain. pedrolloretluna@yahoo.com
authors.forename: Pedro
authors.initials: P
authors.lastname: Lloret
authors.forename: Agustín
authors.initials: A
authors.lastname: España
authors.forename: Ana
authors.initials: A
authors.lastname: Leache
authors.forename: Ana
authors.initials: A
authors.lastname: Bauzá
authors.forename: Marta
authors.initials: M
authors.lastname: Fernández-Galar
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Idoate
authors.forename: Gerd
authors.initials: G
authors.lastname: Plewig
authors.forename: Lothar
authors.initials: L
authors.lastname: Weber
mesh_terms: D000368:Aged; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D015745:Granuloma, Foreign-Body / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007271:Injections, Intradermal; D015474:Isotretinoin / Q000627:therapeutic use*; D019736:Prostheses and Implants
chemical_list: D015474:Isotretinoin; D004318:Doxycycline