Chronic Infection and Nodule Formation following Deoxycholate Injection

Abstract

Aqualyx (Marllor International Ltd, Rimini, Italy) was originally developed in Italy by Professor Pasquale Motolese and has been commercially available since 2009. It is a deoxycholate, aqueous gelatinous solution mixed with saline and buffering compounds. It is the only drug approved by the European Union for the reduction in localized fat. Aqualyx is sold exclusively to doctors and nurses trained in intralipotherapy. In the case of our patient, the product administered was advertised as Aqualyx, but was not administered by a trained health professional and was administered too superficially. The patient developed severe pain following the injection and was unable to sit for several weeks. There was localized skin necrosis, and palpable collections where the injection was administered. Our initial suspicion was development of an abscess or hematoma. To characterize further, we arranged an ultrasound scan that showed a “superficial hypoechoic lesion” but no deeper infection or spread. The numerous painful nodules ruptured onto the skin surface, resulting in purulent and bleeding lesions. This case demonstrates the importance of appropriate training and competence in performing cosmetic procedures including injections and fat dissolving treatments.

Topical formulation of sodium deoxycholate for submental lipolysis

“…Recent studies, however, present the adverse effects from the injection of DCA-based solutions in the form of marginal/pseudomarginal mandibular nerve injury, bruising, injection site alopecia, localized skin necrosis, and superficial hypoechoic lesions. [2][3][4] Complications associated with SMF reduction using Kybella stem from painful repeated subcutaneous injections. Herein, we introduce a proprietary topical formulation of sodium deoxycholate (SCAI-NaDC), developed by SCAI Therapeutics, capable of reducing SMF with minimal side effects.…”