Effect of injection solutions in the dispersion of syringe lubricant (silicone oil)

Authors' response: Platelet-rich plasma injections and the development of cutaneous sarcoid lesions: A case report

“…There is considerable evidence in the literature that silicone oil from silicone injections and silicone breast implants may cause systemic autoimmune reactions. 3 Although Lemes et al 4 described a case of syringe silicone oil causing local dermatologic reactions, to our knowledge there are no reports of silicone oil from a syringe that resulted in systemic autoimmune reactions. Therefore, although it might be plausible for our patient's cutaneous lesions to be due to siliconoma formation, it is highly unlikely that silicone oil caused the characteristic sarcoidosis finding of pulmonary lymph node granuloma formation observed in our patient.…”

Silicone-rich syringes can cause granuloma-rich reactions in platelet-rich plasma injections

“…They attributed the lesions to the Koebner phenomenon; however, they neglected to consider the effect of the foreign material that is expelled in injections from lubricated syringes, the syringe lubricant, silicone oil. 2 …”

“…There is sound evidence that lubricated syringes release silicone oil droplets, especially when agitated by flicking. 3 , 4 Silicone oil–contaminated injected solutions can cause health complications; the 2- to 4-μm droplets will undergo phagocytosis, 2 with subsequent granuloma formation and migration through the lymphatics. 5 Enlarged lymph nodes and skin lesions, like those observed in the patient, are commonly diagnosed as sarcoidosis because of difficulties in the standard histopathology technique, which removes microdroplets of silicone oil during xylene deparaffinization of formalin-fixed paraffin-embedded tissue blocks (unpublished data).…”

“…It is wrong to assume that platelet-rich plasma injections contain no artificial materials because silicone oil is the commonly used syringe lubricant, and contamination with it has been well reported in literature. 2 , 3 , 4 Whether the patient has a history of receiving a specific injection of a foreign material such as silicone oil itself could matter; however, the awareness that silicone oil is inside every syringe, even before blood is drawn for platelet-rich plasma, is of paramount importance. The number of syringes used in the process adds foreign material volume, similar to botulinum toxin: one syringe for reconstitution and another for injection.…”

“…Physicians can use silicone oil–free syringes or perform the previously described flush technique to minimize such rare but important reactions. 2 …”