Delayed immune-mediated adverse effects related to polyacrylamide dermal fillers: clinical findings, management, and follow-up.
BACKGROUND
It has been thought that polyacrylamide (PA) injections do not have inflammatory side effects. Recent evidence shows that local and regional delayed adverse effects may appear with its use.


OBJECTIVE
To evaluate the clinical complaints and follow-up of patients with delayed immune-mediated adverse effects related to PA injections.


METHODS
Prospective, case-series study of 10 patients with delayed adverse effects related to PA injections. Only patients with intermediate or delayed adverse effects related to polyacrylamide injection were included. Patients with immediate side effects were excluded. Patients underwent clinical management, follow-up, and when possible, blood tests and biopsy.


RESULTS
Average latency period to onset of symptoms was 10 months (range 2-36). Tender, inflammatory nodules--granulomas--with pseudo-abscesses were commonly seen. Laboratory abnormalities were found in all analyzed cases. After 20.1 months average follow-up, five patients were in remission, two had recurrent bouts, and three were lost to follow-up, one of them in remission.


CONCLUSIONS
Although it happens infrequently, local and regional delayed and recurrent granulomatous reactions may complicate PA gel injections.
Alijotas-Reig
Jaume
J
Department of Internal Medicine I, Vall d'Hebron University Hospital, Barcelona, Spain. jalijotas@vhebron.net
Garcia-Gimenez
Victor
V
Miró-Mur
Francesc
F
Vilardell-Tarrés
Miquel
M
D000180:Acrylic Resins / Q000009:adverse effects*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003357:Cosmetic Techniques; D005145:Face; D005260:Female; D006099:Granuloma / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D006801:Humans; D020100:Hydrogels / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects*; D013997:Time Factors
D000180:Acrylic Resins; D000893:Anti-Inflammatory Agents; C486838:Aquamid; D020100:Hydrogels