Journal of Clinical and Aesthetic Dermatology

APR 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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52 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 C A S E r E p o r T all unremarkable. Based on the patient's clinical presentation and objective findings, a diagnosis of metastatic silicone granulomas was made. After discussion of treatment options, the patient elected intralesional triamcinolone injections and minocycline therapy as initial treatment options. Injections were placed into the nodular areas of the right labia and right inferior buttock. The patient was also started on oral minocycline 100mg twice daily. The patient reported mild improvement after one month of therapy, and treatment with intralesional triamcinolone plus oral mincocycline was continued. DISCUSSION Liquid injectable silicone has long been used as a soft tissue augmentation agent, having many innate properties that make it well- suited to this purpose. It is noncarcinogenic, minimally antigenic, can easily be sterilized, and its viscosity remains consistent across the range of temperatures experienced in the human body. 1 Proper injection of pharmaceutical-grade liquid silicone using the microdroplet technique ensures that the material is appropriately encapsulated in a network of fibrous tissue, which produces superior cosmetic results and prevents substance migration. 1 In contrast, large-volume injections of silicone of unknown purity are more prone to substance migration and other complications, including edema, pneumonitis, cellulitis, ulcerations, and granuloma formation. 1–6 Large- volume injections frequently have adulterants added to the silicone, which are intended to induce a more vigorous fibrotic reaction that slows substance migration. 1 While there is a higher overall complication rate associated with large-volume impure silicone injections, a granulomatous response to silicone injection can occur with medical- and nonmedical-grade silicone injections. 7 Since silicone can Figure 3. Significant swelling of the right labia majora with subtle overlying erythema. The round atrophic pink macule on the right buttock is a biopsy scar. Figure 4. Hematoxylin and eosin stain, 400x original magnification. Dense granulomatous infiltrate in the dermis and subcutis with clear vacuoles within histiocytes consistent with silicone granulomas

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