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Granulomatous Diseases of the Skin

»What is meant by “granulomatous diseases of the skin”?
»Explain the role of histiocytes in granulomas.
»What is the difference between an immune granuloma and a foreign body granuloma?
»List some common granulomatous diseases that affect the skin.
»Can granulomas be recognized clinically?
»How do endogenous “foreign” bodies cause granulomas?
»What are the sources of the exogenous foreign body agents?
»Do cosmetic fillers ever produce foreign body granulomas?
»Can the cause of a foreign body reaction be diagnosed histologically?
»What is sarcoidosis?
»How often is the skin involved in sarcoidosis?
»Describe the specific cutaneous findings in sarcoidosis.
»What is lupus pernio?
»Describe the nonspecific cutaneous lesions of sarcoidosis.
»Does sarcoidosis ever present in the skin without extracutaneous involvement?
»What is Löfgren’s syndrome?
»What is Heerfordt’s syndrome?
»How should cutaneous sarcoidosis be treated?
»What is the typical presentation of granuloma annulare?
»Do any systemic associations occur with granuloma annulare?
»What is the typical course of granuloma annulare?
»How is granuloma annulare treated?
»What is actinic granuloma?
»Are rheumatoid nodules really a granulomatous disorder?
»Where do rheumatoid nodules typically occur?
»What causes rheumatoid nodules?
»What is accelerated nodulosis?
»Are rheumatoid nodules specific for rheumatoid arthritis?
»Do patients with lupus miliaris disseminatus faciei have lupus erythematosus?

 
 
 

Do cosmetic fillers ever produce foreign body granulomas?

Patient with foreign body reaction to cosmetic filler demonstrating erythematous papules and linear lesions at the site of bovine collagen injection. (Courtesy of the Fitzsimons Army Medical Center teaching files.)
Fig. 13.2 Patient with foreign body reaction to cosmetic filler demonstrating erythematous papules and linear lesions at the site of bovine collagen injection. (Courtesy of the Fitzsimons Army Medical Center teaching files.)
Yes. Numerous cosmetic fillers, including products made from collagen (Fig. 13-2), silicone, hyaluronic acid, methacrylate, and polyalkylimide, have been reported to produce foreign body granulomas. In some cases the cosmetic results have been very poor and difficult to correct. The number of reported cases is rapidly increasing as the cosmetic filler industry has rapidly expanded in the last decade and larger numbers of patients are receiving injections for cosmetic fillers.

Sanchis-Bielsa JM, Bagán JV, Poveda R, Salvador I: Foreign body granulomatous reactions to cosmetic fillers: a clinical study of 15 cases, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:237–241, 2009.

Winslow CP: The management of dermal filler complications, Facial Plast Surg 25:124–128, 2009.