Delayed Immune-Mediated Adverse Effects Related to Polyacrylamide Dermal Fillers

Alijotas‐Reig, Jaume; Garcia-Gimenez, Victor; Miró-Mur, Francesc; Vilardell‐Tarrés, Miquel

doi:10.1111/j.1524-4725.2008.01041.x

Cited by 39 publications

(43 citation statements)

References 32 publications

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“…data] – may be mainly due to a delayed type IV hypersensitivity reaction. In cases where antibiotics seem to be useful, it is unclear whether this is due to bactericidal properties or their anti-inflammatory and/or immune-modulating effects [20,35]. In this series of patients, the long-term follow-up showed better outcomes than those obtained in similar series of patients with delayed-onset side effects related to other bio-implants [19,10,22].…”

Section: Discussioncontrasting

confidence: 41%

“…Allopurinol was administered to 1 patient (case 2). Allopurinol has also been used as a treatment of cutaneous sarcoidosis and granuloma related to implant fillers, PLLA included [20,33,34]. Although in our series there was no clinical evidence of bacterial infection, according to the suggestion of Christensen et al [21], antibiotics were used in 1 patient (10%), but with no improvement; therefore, the relevance of antibiotic treatment may be questioned [10,19].…”

Section: Discussionmentioning

confidence: 78%

“…Delayed granulomatous reactions have been related to collagen, silicone, polyalkylimide, polyacrylamide, hyaluronic acid, Gore-Tex® and methacrylate implants [1,5,19,20,21]. The same type of adverse reactions has been described with the use of combinations of methacrylate-collagen and ethylmethacrylate-hyaluronic acid [22].…”

Section: Discussionmentioning

confidence: 83%

“…Antimalarials also have many anti-inflammatory, anti-aggregant and immune-regulatory properties [31]. Cases of granulomatous reactions secondary to implant fillers have been treated with hydroxychloroquine [19,20,22,32]. Allopurinol was administered to 1 patient (case 2).…”

Section: Discussionmentioning

confidence: 99%

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Late-Onset Immune-Mediated Adverse Effects after Poly-<i>L</i>-Lactic Acid Injection in Non-HIV Patients: Clinical Findings and Long-Term Follow-Up

2009

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Background: It has been thought that poly-L-lactic acid (PLLA) injections do not have inflammatory side effects. Recent evidence shows that local/regional/systemic delayed adverse effects may appear with its use. Objective: To evaluate the clinical complaints, treatment response and long-term follow-up of non-HIV patients with delayed immune-mediated adverse effects related to PLLA injections. Methods: Prospective, case series study of 10 patients with delayed adverse effects related to PLLA injections. The inclusion criterion was defined as the onset at least 6 months after PLLA use, with 1 or more of the following clinical signs: oedema, skin induration, swelling/tender nodules with or without discharge of pus or filler material. Several systemic manifestations were also included. Patients with immediate side effects were excluded. Patients underwent clinical management and long-term follow-up. Results: The average latency period to the onset of symptoms was 19.2 months (range: 6–60). Tender, inflammatory nodules and facial oedema were commonly seen. One case presented a systemic granulomatous disorder as a complication. After 50.2 months of average follow-up (range: 38–78), 5 patients are in remission, 4 have recurrent bouts and the last case has been lost to follow-up. Conclusion:Although infrequently, local and/or regional and/or systemic delayed and recurrent granulomatous reactions may complicate PLLA gel injections.

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Late-Onset Immune-Mediated Adverse Effects after Poly-<i>L</i>-Lactic Acid Injection in Non-HIV Patients: Clinical Findings and Long-Term Follow-Up

2009

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“…Blood samples were taken from 110 patients of this cohort. Thereafter, peripheral blood mononuclear cells were obtained according to standard procedures to perform different other studies apart from those mentioned above [11,18,19,20,21,22]. …”

Section: Methodsmentioning

confidence: 99%

Are Bacterial Growth and/or Chemotaxis Increased by Filler Injections? Implications for the Pathogenesis and Treatment of Filler-Related Granulomas

et al. 2010

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Background: As microbial agents have been associated with late adverse effects related to fillers antibiotic treatment has been envisaged. Objective: To determine whether biomaterials favor bacterial growth and/or attract bacteria. Methods: Hyaluronic acid, semi-permanent fillers, such as calcium hydroxylapatite, and permanent fillers, such as polyalkylimide/polyacrylamide, were used. Experiments were performed with Escherichia coli, strain HVH-U47. Bacteria were transferred to Sven-Gard agar to test mobility. Striae of this bacterial strain with a MacFarland 1 turbulence pattern were seeded from a spot of inoculated biomaterial using Müller-Hinton medium. The chemoattractive properties of the biomaterials were analyzed 10 days after inoculation. Bacterial growth over the biomaterial and in-depth growth were assessed as well. Results: Semi-permanent fillers did not stimulate bacterial growth but they allowed bacterial colonization over the filler. Permanent acrylic compounds neither presented chemoattractant properties nor showed bacterial growth over the biomaterial. Similar results were obtained when performing in-depth cultures. Conclusions: Permanent and semi-permanent fillers did not facilitate bacterial growth when flagellated E. coli HVH-U47 was used. Our results do not argue in favor of antibiotics as the mainstay of therapy in late granulomas related to permanent fillers. In the case of resorbable/semi-permanent fillers, more studies are needed before recommending antibiotic therapy.

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Delayed Inflammatory Reaction to Bio-Alcamid Polyacrylamide Gel Used for Soft-Tissue Augmentation

Chrastil-LaTowsky¹,

Wesley²,

MacGregor³

et al. 2009

Arch Dermatol

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Background: Given the recent boom of the cosmetic industry, there is a wealth of new products available to patients and physicians, including soft-tissue fillers. Bio-Alcamid polyacrylamide gel (Polymekon, Milan, Italy) is a filler that has potential to cause adverse reactions. Observations: Two patients who had previously been treated with Bio-Alcamid outside of the United States presented with different manifestations of inflammatory responses to the product. These reactions were challenging to treat. Conclusions: Despite claims of safety, Bio-Alcamid and possibly other soft-tissue fillers available worldwide have the potential to cause adverse reactions. Physicians should be aware of the various presentations and treatment options for these reactions.

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Delayed Immune-Mediated Adverse Effects Related to Polyacrylamide Dermal Fillers

Abstract: Although it happens infrequently, local and regional delayed and recurrent granulomatous reactions may complicate PA gel injections.

Cited by 39 publications

References 32 publications

Late-Onset Immune-Mediated Adverse Effects after Poly-<i>L</i>-Lactic Acid Injection in Non-HIV Patients: Clinical Findings and Long-Term Follow-Up

Late-Onset Immune-Mediated Adverse Effects after Poly-<i>L</i>-Lactic Acid Injection in Non-HIV Patients: Clinical Findings and Long-Term Follow-Up

Are Bacterial Growth and/or Chemotaxis Increased by Filler Injections? Implications for the Pathogenesis and Treatment of Filler-Related Granulomas

Delayed Inflammatory Reaction to Bio-Alcamid Polyacrylamide Gel Used for Soft-Tissue Augmentation

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