The strive for proficient cosmetic facial appearance is growing in the past decades. Fillers for tissue augmentation are gaining wide popularity. Uncertified products based on oleic solutions are applied by untrained staff, thus growing the risk for certain complications such as infections, allergic and irritant contact dermatitis, and lipogranuloma formation. We present a series of three cases lipogranuloma after liquid vitamin E injection for lip augmentation. In all cases, painful edema at the injected area followed the procedure. The patients were presented with erythema, firm indurations of the lips and the perioral skin, and tenderness. Histological examination of skin biopsies showed round-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with a lipogranuloma. In this paper, we propose a protocol for treatment of this specific complication with systemic corticosteroids and a broad spectrum antibiotics.
Fillers for lip augmentation have become more and more popular in recent years and seem to be indispensable in the cosmetic market nowadays. A series of six young females is presented who developed massive swellings and pain after vitamins A and/or E lip augmentation. The vitamins were extracted from gelatinous capsules (Gericaps [Adipharm EAD, Sofia, Bulgaria], Geritamins [Actavis EAD, Balkanpharma-Dubnitsa AD, Bulgaria], or vitamin E yellow gel capsules) and injected by unprofessional physicians and beauticians in different cosmetic centers. Physical examination revealed firm indurations of the lips and perioral skin, tenderness, erythema, and hard dermal nodules. Histological analysis revealed numerous round-to-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with lipogranulomas. The patients were treated with systemic and intralesional triamcinolone injections and broad-spectrum antibiotics with good clinical response. In conclusion, these cases demonstrate the danger of the use of unregistered products as fillers injected by unprofessional physicians and beauticians.
Graham-Little-Piccardi-Lassueur syndrome (GLPLS) is a rare syndrome characterized by the triad of cicatricial alopecia of the scalp, non-cicatricial alopecia of the axilla and groin and follicular lichen planus eruptions on the trunk and extremities. GLPLS is considered to be a variant of lichen planopilaris. We report two cases that have fulfilled all of the criteria for GLPLS. The first case was a 71-year-old woman, admitted to the Department of Dermatology for pruritic perifollicullar erythema and scaling of the scalp, cicatricial scalp alopecia and hair loss of the axilla and pubic region for five months. Subsequently, follicular hyperkeratotic eruptions and hyperpigmented macules on the skin of the chest and abdomen appeared. The second case was a 48-year-old man with pruritic follicular papules on the face, trunk and extremities for four months. All of the laboratory examinations in both patients were within normal limits. No alternation in the general condition of the patients was observed. Histological examinations in both patients confirmed the diagnosis GLPLS. The patients were treated with systemic and local corticosteroid resulting in marked improvement of the skin lesions; however, cicatricial scalp alopecia showed no response to the treatment.
The group of congenital limb overgrowth syndromes associated with vascular malformations include various disorders, often with variable clinical expression. Klippel-Trenaunay syndrome is the most common syndrome in this group, compared to other similar disorders such as Proteus, Parkes-Weber, Sturge-Weber, Cobb, Maffucii and CLOVES syndromes. We present a case of a 55-year-old male who presented with swelling, pain, heaviness, numbness and increased local temperature, involving the right upper extremity and the right side of the chest wall and associated with a livid erythema. The patient had several comorbidities including arterial hypertension and ischemic heart disease. He also had a family history of diabetes mellitus. A multidisciplinary team-based treatment approach, including physicians with expertise in various medical and surgical specialties was applied with the patient being “the unifying focus” of all these experts and their efforts. A personal approach tailored to the patient’s preferences was the key to a successful treatment.
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