Cutaneous silica granuloma. A rare entity or rarely diagnosed? Report of two cases with review of the literature

Uncommon Foreign Body Reactions Occurring in the Lip: Clinical Misdiagnosis and the Use of Special Techniques of Analysis

“…According to these microscopic findings alone, several differential diagnoses could be considered-from tuberculosis, certain fungal infections, lepromatous leprosy and sarcoidosis to certain foreign-body reactions [15][16][17][18][19]. Although the polarized light microscopy excluded the majority of these interesting hypotheses, it would have been perfect if the compounds could have been analyzed by X-ray dispersive energy analysis, as performed in other studies [15,16,18].…”

“…Silica granuloma is a poorly understood, uncommon condition and other foreign bodies, such as powders, talc or starch, can produce similar microscopic findings [15][16][17][18][19][20]. Generally, the treatment of choice is complete surgical excision of the lesion, but intralesional steroid injections, systemic steroids and antibiotics have been considered as alternative treatments.…”

Polishing-Paste-Induced Silica Granuloma of the Gingiva

“…Two major theories exist today: one suggesting that the granuloma is induced by the colloidal state of the silica resulting from chemical ‘weathering’ in the tissues during many years [6], the other proposing that this type of granuloma arises as a delayed hypersensitivity response only in susceptible individuals [7]. The first theory would explain the long latency period, from months to several decades before the appearance of the lesion, but not the simultaneous presence of multiple granulomas in different body sites observed in some patients [8]. Furthermore, supporting the second theory, cases of sarcoidosis developing in silica-containing scars are numerous [9, 10, 11, 12, 13].…”

“…Furthermore, supporting the second theory, cases of sarcoidosis developing in silica-containing scars are numerous [9, 10, 11, 12, 13]. Although some of these may be silica granulomas not appropriately investigated [8], it must be considered that an outbreak of inflammation in a previously quiescent and sometimes very old silicotic granuloma might be a local symptom of an acquired systemic sarcoidosis [14]that has been compared with a spontaneous Kveim reaction [9]. …”

Summary of Notifiable Noninfectious Conditions and Disease Outbreaks: Surveillance for Silicosis — Michigan and New Jersey, 2003–2010

“…In one study, alcohol consumption (quantity not specified) may have been a confounder [Okrouhlílik and Hykeš 1983]. Mowry et al [1991] reported a case of a cutaneous silica granuloma in a 57-year-old stonemason. Silica granulomas are firm, nontender dermal or subcutaneous nodules that usually appear at least several years (mean=10 years) after the exposure to silica.…”