title: Foreign body granuloma due to Matridex injection for cosmetic purposes.
abstract: A new resorbable filler, Matridex, became commercially available during the last years with scarce evidence regarding side effects. A 43-year-old woman complained of multiple, painful, reddish, nonulcerated, hard nodules on both cheeks and periocular regions. Four weeks before, she had been injected by a general practitioner with Matridex for aesthetic purposes to correct wrinkles in the same areas of the nodular eruption. Histopathology showed a diffuse suppurative granulomatous reaction with the presence of multinucleate giant cells and many neutrophils involving the entire dermis. No areas of caseation were observed. The inflammatory granulomatous reaction surrounded 2 different types of nonpolarizing, bluish, exogenous material: one arranged in filamentous structures and the second composed by large spherical particles. All nodules were incised and drained; the patient received systemic antibiotic treatment for 2 consecutive weeks. The nodules progressively regressed and almost complete resolution was seen after 6 months. Matridex is a new resorbable filler constituted by a mixture of nonanimal-stabilized hyaluronic acid (HA), cross-linked HA, and dextranomer microspheres. Foreign body reactions have been described in association with other HA fillers, but a granulomatous reaction after the injection of Matridex has not been reported yet. Interestingly, in our patient, we were able to identify both fragments of HA: the filamentous particles and the spherical particles of dextranomer microspheres within the infiltrate, these last giving a characteristic and recognizable appearance to the histopathological picture.
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: Cesare
authors.initials: C
authors.lastname: Massone
authors.forename: Michael
authors.initials: M
authors.lastname: Horn
authors.forename: Helmut
authors.initials: H
authors.lastname: Kerl
authors.forename: Christina M
authors.initials: CM
authors.lastname: Ambros-Rudolph
authors.forename: Alexandra Maria
authors.initials: AM
authors.lastname: Giovanna Brunasso
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cerroni