Scar sarcoidosis after hyaluronic acid injection.
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.
Dal Sacco
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D
DiSEM, Section of Dermatology, University of Genoa, 16132 Genoa, Italy.
Cozzani
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E
Parodi
Aurora
A
Rebora
A
A
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects*; D002921:Cicatrix / Q000473:pathology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D007267:Injections; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D012871:Skin Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology
D000276:Adjuvants, Immunologic; D005938:Glucocorticoids; D006820:Hyaluronic Acid; C445361:Restylane; D011241:Prednisone