title: Cosmetic permanent fillers for soft tissue augmentation: a new contraindication for interferon therapies.
abstract: BACKGROUND
  Most of the new fillers used for soft tissue augmentation in aesthetic dermatology are considered well tolerated, but very little data are available on their long-term tolerability, especially in patients receiving immunomodulatory therapy.
  
  
  METHODS
  A 48-year-old woman presented with disfiguring facial edema 10 weeks after she began antiviral therapy with peginterferon alfa-2a and ribavirin for chronic hepatitis C infection. The major affected sites had been treated 10 years before with Artecoll, a permanent filler containing polymethylmethacrylate. A treatment attempt with allopurinol was initiated while antiviral therapy was continued and was successfully completed after 6 months. Despite significant improvement, extended plastic surgery was necessary for facial reconstruction.
  
  
  CONCLUSIONS
  The normal host response to a cosmetic filler is a weak granulomatous reaction. Interferon and other immunostimulatory medications can lead to an exacerbation of this preexisting low-grade chronic inflammation that is quite similar to interferon-triggered sarcoidosis. This potential long-term risk has medicolegal implications for informed consent and for the potential use of both permanent fillers and interferon.
authors: Department of Dermatology, Eberhard-Karls-University Tübingen, Tübingen, Germany.
authors: Joerg
authors: J
authors: Fischer
authors: Gisela
authors: G
authors: Metzler
authors: Martin
authors: M
authors: Schaller
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003094:Collagen; D003357:Cosmetic Techniques; D005145:Face; D005260:Female; D015745:Granuloma, Foreign-Body / Q000139:chemically induced / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000188:drug therapy; D006801:Humans; D007267:Injections; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D019904:Polymethyl Methacrylate; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000276:Adjuvants, Immunologic; D000998:Antiviral Agents; C445359:Artecoll; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D003094:Collagen; D019904:Polymethyl Methacrylate; C100416:peginterferon alfa-2a