Foreign body granulomas after all injectable dermal fillers: part 2. Treatment options.
Foreign body granulomas occur at certain rates with all injectable dermal fillers. They have to be distinguished from early implant nodules, which usually appear 2 to 4 weeks after injection. In general, foreign body granulomas appear after a latent period of several months at all injected sites at the same time. If diagnosed early and treated correctly, they can be diminished within a few weeks. The treatment of choice of this hyperactive granulation tissue is the intralesional injection of corticosteroid crystals (triamcinolone, betamethasone, or prednisolone), which may be repeated in 4-week cycles until the right dose is found. To lower the risk of skin atrophy, corticosteroids can be combined with antimitotic drugs such as 5-fluorouracil and pulsed lasers. Because foreign body granulomas grow fingerlike into the surrounding tissue, surgical excision should be the last option. Surgery or drainage is indicated to treat normal lumps and cystic foreign body granulomas with little tissue ingrowth. In most patients, a foreign body granuloma is a single event during a lifetime, often triggered by a systemic bacterial infection.
Lemperle
Gottfried
G
San Diego, Calif.; and Paris, France From the Division of Plastic Surgery, University of California, San Diego, and private practice.
Gauthier-Hazan
Nelly
N
D000779:Anesthetics, Local / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use*; D020405:Dermis; D004359:Drug Therapy, Combination; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D015745:Granuloma, Foreign-Body / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use*; D008911:Minocycline / Q000627:therapeutic use*; D014221:Triamcinolone / Q000627:therapeutic use*
D000779:Anesthetics, Local; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000964:Antimetabolites, Antineoplastic; D014221:Triamcinolone; D001623:Betamethasone; D008012:Lidocaine; D008911:Minocycline; D005472:Fluorouracil; D008775:Methylprednisolone