C a se Re p o rt A Fo re ig n Bo d y G ra nulo m a d ue to a De rm a l Fille r: Lim ite d Re sp o nse to Intra le sio ne l a nd Syste m ic Ste ro id Tre a tm e nt İlgen Ertam,* MD, İdil Ünal, MD, Tuğrul Dereli, MD, Alican Kazandı, MD, Sibel Alper, MD Address: Department of Dermatology, Ege University, Medical Faculty, Bornova, Izmir, 35040, Turkey E-mail: iertam@yahoo.com * Corresponding author: İlgen Ertam, MD, Ege University Medical Faculty, Department of Dermatology, Bornova, Izmir, 35040, Turkey Pub lishe d : J Turk Ac a d De rma to l 2008; 2 (4): 82401c This a rtic le is a va ila b le fro m: http :/ / www.jta d .o rg / 2008/ 4/ jta d 82401c .p d f Key Words: fo re ig n b o d y g ra nulo ma , fille r A b stra c t O b se rva tio ns: A 72-ye a r-o ld wo ma n p re se nte d to o ur c linic with e d e ma o n he r fa c e . The p a tie nt re p o rte d tha t she und e rwe nt a ug me nta tio n o f he r fa c e with a d e rma l fille r 3 mo nths a g o . She d id no t kno w the na me o f the fille r. O n d e rma to lo g ic e xa mina tio n, b ila te ra l e ye lid a nd fa c ia l o d e ma , firm, irre g ula r sub c uta ne o us no d ule s we re o b se rve d . Skin b io p sy sho we d fo re ig n b o d y g ra nulo ma , mic ro c yst fo rma tio n a nd p ink, p o lyg o na l, tra nsluc e nt ma te ria l. The a ffe c te d a re a s tre a te d with 60 mg / d o ra l c o rtic o ste ro id d uring 2 mo nths a t ta p e ring d o se s a nd re p e a te d intra le sio na l c o rtic o ste ro id inje c tio ns (20 mg / ml). Fa c ia l o d e ma d isa p p a re d , b ut firm no d ule s slig htly imp ro ve d . He re , we re p o rt a c a se with fo re ig n b o d y g ra nulo ma s to a d e rma l fille r, its tre a tme nt a nd d isc uss histo p a tho lo g ic a l d iffe re ntia l d ia g no sis. Introduction Wrinkle reduction using dermal fillers are now widely performed by dermatologists and plastic surgeons. Various adverse ef- fects due to the fillers can be seen. While early reactions are temporary, late reactions tend to be permanent. Case Report A 72-year-old woman presented to our clinic with solid facial oedema. The patient reported that she underwent augmentation of her face with a dermal filler 3 months ago. She did not know the name of the filler. There were no aller- gic rhinitis, asthma and anaphylactoid reactions in her personal and family history. On derma- tologic examination, bilateral eyelid and facial oedema, firm, irregular subcutaneous nodules were seen (Figure 1a). Skin biopsy showed mul- tiple small translucent pinkish particles of slightly different sizes, polygonal or irregularly shaped with a variable lymphocytic infiltrate and multinucleated giant cells (Figure 2). Routine blood tests, levels of antinuclear antibody, angio- converting enzyme, creatinine phosphokinase (CPK) were normal. The patient treated with 60mg/d corticosteroid during one month at tapering doses and re- peated intralesional injections of triamcinolone acetonide (20 mg/dl). Facial oedema disap- peared, but firm nodules slightly improved (Figure 1b). Informed consent was obtained from the patient. Discussion All dermal fillers can lead to adverse reac- tions. Reactions can be attributed to the procedural technique, and the agent in- jected. Hyaluronic acid derivatives are the most used reabsorbable dermal fillers re- cently. Reports about long-term adverse Pa g e 1 o f 3 (p a g e numb e r no t fo r c ita tio n p urp o se s) eISSN 1307 eISSN 1307- 394X 394X