Background
Hyaluronic acid filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler.
Methods
The institution's dermatopathology electronic database was retrospectively searched for histopathologic reactions to hyaluronic acid from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded.
Results
From 2014 to 2019, there were 15 cases of granulomatous reactions to hyaluronic acid filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of hyaluronic acid filler.
Conclusion
A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.
FIGURE 4. Many hyperchromatic spindled and epithelioid cells (H&E, original magnification ×20).FIGURE 5. PHH3 immunostain highlighted a rare mitotic figure within the dermal proliferation (original magnification ×20).
Our current understanding of psoriasis has only been established recently in the course of its history. The intent of this article is to take a historical look at the timeline of how psoriasis came to be what we know it as today. It discusses the evolution of our understanding of the pathogenesis of psoriasis and the various treatment modalities that have been further fine-tuned overtime. The article concludes with a discussion about the more novel biologic therapies used currently and treatments for the future. It is clear by its puzzling history that psoriasis is no simple disease. It is useful to be cognizant of the mistakes of our predecessors as confusion about the disease dates back thousands of years. Ongoing research continues to recognize more about this conundrum, which we finally agreed to call psoriasis in the last century.
Papillary dermal elastolysis has been described in the setting of experimental combination nivolumab and cabiralizumab immunotherapy. We report a third patient with distinctive, generalized atrophic macules that developed after a morbilliform eruption during a clinical trial for treatment of metastatic pancreatic adenocarcinoma. Histopathological findings demonstrated diminished elastic fibers in the papillary dermis, associated with a histiocyte-rich infiltrate and increased dermal mucin, features that should clue the dermatopathologist to this condition.
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