title: A case series and a review of the literature on foreign modelling agent reaction: an emerging problem.
abstract: Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.
authors.affiliation: Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Martínez-Villarreal
authors.affiliation: Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Daniel
authors.initials: D
authors.lastname: Asz-Sigall
authors.affiliation: Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Daniela
authors.initials: D
authors.lastname: Gutiérrez-Mendoza
authors.affiliation: Department of Clinical Research, SerenaGroup Wound and Hyperbaric Centers, Cambridge, MA, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Serena
authors.affiliation: Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Adriana
authors.initials: A
authors.lastname: Lozano-Platonoff
authors.affiliation: Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Lourdes Y
authors.initials: LY
authors.lastname: Sanchez-Cruz
authors.affiliation: Section of Dermatopathology, Department of Dermatology, Dr Manuel Gea Gonzalez General Hospital, Mexico City, Mexico.
authors.forename: Sonia
authors.initials: S
authors.lastname: Toussaint-Caire
authors.affiliation: Department of Dermatology, "Dr. Salvador Zubirán" National Institute of Medical Sciences and Nutrition, Tlalpan, Mexico.
authors.forename: Judith
authors.initials: J
authors.lastname: Domínguez-Cherit
authors.affiliation: Department of Dermatology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Lirio A
authors.initials: LA
authors.lastname: López-García
authors.affiliation: Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cárdenas-Sánchez
authors.affiliation: Department of Dermatology, Interdisciplinary Wound and Ostomy Care Center, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
authors.forename: José
authors.initials: J
authors.lastname: Contreras-Ruiz
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000503:physiopathology; D002081:Buttocks / Q000503:physiopathology; D003358:Cosmetics / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005547:Foreign Bodies / Q000276:immunology*; D005549:Foreign-Body Reaction / Q000150:complications*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008899:Mineral Oil / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012867:Skin / Q000503:physiopathology; D012883:Skin Ulcer / Q000209:etiology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D003358:Cosmetics; D008899:Mineral Oil
keywords: Autoimmune/inflammatory syndrome induced by adjuvants; Foreign body reaction; Foreign modelling agent reaction (FMAR); Human adjuvant disease; Iatrogenic allogenosis; Modelling disease; Oleoma; Paraffinoma; Siliconoma; Skin ulcer