A Clinicopathologic Study of Injection-induced Foreign Body Granuloma

Shim, Woo Haing; Jwa, Seung Wook; Song, Margaret; Kim, Hoon Soo; Ko, Hyun Chang; Kim, Byung Soo; Kim, Moon Bum

Abstract

BACKGROUND
Various foreign materials injected into the skin can cause foreign body granuloma, which can cause severe disfigurement.
OBJECTIVE
To describe the clinicopathological characteristics of injection-induced foreign body granuloma.
METHODS
We did a retrospective study of 27 cases of injection-induced foreign body granuloma. Factors investigated included sex, age, injected material, purpose of injection, operator who gave the injection, number of injections, onset time of the granuloma after the injection, affected parts of the body, cutaneous manifestations, associated symptoms, histopathologic findings, treatment modalities and clinical course.
RESULTS
The male-female ratio was 2 to 25. Twenty five patients received injection for cosmetic improvement and 2 patients for treatment of musculoskeletal disease. Twenty patients were treated by unlicensed practitioners. The injected materials were unknown in 14 cases, whereas silicone (n=5) was most common among known injected materials. On average, foreign body granuloma occurred 131.3+/-136.3 months after injection. The face was the most frequently affected site and usually presented as skin-colored or erythematous plaques. The histopathologic exam revealed variable infiltration of inflammatory cells, including lymphocytes, histiocytes, multinucleated giant cells, plasma cells, neutrophils, and eosinophils. A swiss cheese appearance was observed in 19 cases. Complete response was achieved in four patients: those who had been treated with surgical excision (n=2) and those treated with systemic corticosteroids with antibiotics (n=2).
CONCLUSION
Foreign body granuloma can arise from injection of various foreign materials. Dermatologists should be aware of the clinical manifestations of injection-related foreign body granuloma to make an appropriate diagnosis and to provide proper treatment. Moreover, there should be great social concern about injection-related foreign body granuloma, because many cases are caused by unlicenced practitioners.