title: Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options.
abstract: Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, 2nd floor, Miami, FL, 33136, USA, JLedon1@med.miami.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Ledon
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Savas
authors.forename: Steven
authors.initials: S
authors.lastname: Yang
authors.forename: Katlein
authors.initials: K
authors.lastname: Franca
authors.forename: Ivan
authors.initials: I
authors.lastname: Camacho
authors.forename: Keyvan
authors.initials: K
authors.lastname: Nouri
mesh_terms: D000180:Acrylic Resins / Q000009:adverse effects; D000273:Adipose Tissue / Q000637:transplantation; D001672:Biocompatible Materials / Q000009:adverse effects*; D003094:Collagen / Q000009:adverse effects; D003879:Dermatologic Agents / Q000009:adverse effects*; D017886:Durapatite / Q000009:adverse effects; D015745:Granuloma, Foreign-Body / Q000139:chemically induced* / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects; D020100:Hydrogels / Q000009:adverse effects; D019344:Lactic Acid / Q000009:adverse effects; D008768:Methylmethacrylates / Q000009:adverse effects; D011091:Polyesters; D011102:Polyhydroxyethyl Methacrylate / Q000009:adverse effects / Q000031:analogs & derivatives; D011108:Polymers / Q000009:adverse effects; D019904:Polymethyl Methacrylate / Q000009:adverse effects; D012828:Silicones / Q000009:adverse effects; D014180:Transplantation / Q000009:adverse effects; D000099166:Polyacrylamides
chemical_list: D000180:Acrylic Resins; D001672:Biocompatible Materials; D003094:Collagen; D003879:Dermatologic Agents; D017886:Durapatite; D006820:Hyaluronic Acid; D020100:Hydrogels; D019344:Lactic Acid; D008768:Methylmethacrylates; D011091:Polyesters; D011102:Polyhydroxyethyl Methacrylate; D011108:Polymers; D019904:Polymethyl Methacrylate; D012828:Silicones; D000099166:Polyacrylamides; C000257:polyhydroxyethyl methacrylate hydrogels; C033616:poly(lactide); C009931:poly(ethylmethacrylate)