title: Tacrolimus in the treatment of chronic and refractory late-onset immune-mediated adverse effects related to silicone injections.
abstract: BACKGROUND
  Although currently not authorized in many countries, medical-grade silicone (MGS) injections have been used for 50 years. Sometimes chronic and severe adverse effects refractory to usual therapy other than corticosteroids appear.
  
  
  OBJECTIVE
  To evaluate the effectiveness of tacrolimus in the treatment of refractory cases of late-onset adverse effects related to MGS injections.
  
  
  METHODS
  Case-series study of seven patients with late-onset adverse effects related to MGS injections. Cases had been treated with a mean of six drugs with poor response before low-tacrolimus dose was introduced. Patients who had received MGS injections with immediate adverse effects or drug responsiveness were excluded. Patients underwent clinical management and follow-up.
  
  
  RESULTS
  Average latency period to onset of symptoms was 65 months (range: 6-144 months). Large, tender, inflammatory nodules; plaques; angioedema; and severe panniculitis were commonly seen. An average of 18 months after tacrolimus administration, five patients were experiencing mild, sparse bouts of inflammatory processes, including nodules, plaques, angioedema, and panniculitis. that were rapidly reversible, and two were in remission. No side effects related to tacrolimus had appeared.
  
  
  CONCLUSIONS
  Tacrolimus is an effective and well-tolerated drug in cases of severe and refractory late-onset inflammatory reactions, including large panniculitis, that complicate silicone gel injections.
authors: Ageing and Systemic Autoimmune Diseases Research Unit, Department of Internal Medicine I, Vall d'Hebron University Hospital, Barcelona, Spain. 16297jar@comb.es
authors: Jaume
authors: J
authors: Alijotas-Reig
authors: Victor
authors: V
authors: Garcia-Gimenez
authors: Miquel
authors: M
authors: Vilardell-Tarrés
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy* / Q000276:immunology; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012828:Silicones / Q000008:administration & dosage / Q000009:adverse effects*; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D001672:Biocompatible Materials; D007166:Immunosuppressive Agents; D012828:Silicones; D016559:Tacrolimus