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- Page navigation anchor for RE: Resection of oil injection fillers is definitive treatment for recurrent inflammatory complication.RE: Resection of oil injection fillers is definitive treatment for recurrent inflammatory complication.
The case report in the ‘Practice’ section by Prosperi-Porta et al1 highlights a common problem related to the use of ‘fillers’ to increase or sculpt muscle size/definition. It was disappointing to read that the case was not complete, in that discussion on surgical management and outcome was not properly reported. Treatment with tetracycline antibiotics (ex. minocycline, doxycycline), steroids (ex. prednisone, prednisolone), and immune-modulating medications (ex. etanercept) can be trialed.2 Resection, for well-circumscribed foreign materials, is the definitive treatment for ongoing inflammatory response related to this injected foreign body.
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In this case resection was successful. The foreign material was excised from the bilateral anterior upper arms, from within the subcutaneous fat and superficial biceps brachii muscles. Pathology of the specimens removed added no new information to that reported. The patient has had no further episodes of localized inflammation of the biceps since surgery 10 months ago.
In areas of the body that are easily seen, surgical resection can leave scars and contour deformities that can be disturbing to the individual. A recent article by Sharobaro et al3 highlights this problem. Patient education regarding the long term complications of injectable materials is imperative. As seen in the patient reported by Prosperi-Porta et al, chronic inflammation, pain, and impairment can result from fillers. Surgical resection can be per...Competing Interests: None declared.References
- 1. Graeme Prosperi-Porta, Christopher Oleynick, Stephen Vaughan. Myositis from intramuscular oil injections in a bodybuilder. CMAJ 2020;192:E480-E480.
- 2. Singh, Mansher MD; Solomon, Isaac H. MD, PhD; Calderwood, Michael S. MD, MPH; Talbot, Simon G. MD Silicone-induced Granuloma After Buttock Augmentation, Plastic and Reconstructive Surgery - Global Open: February 2016 - Volume 4 - Issue 2 - p e624 doi:
- 3. Sharobaro VI, Manturova NE, Ivanov YV, Avdeev AE, Zabozlaev FG, Telnova AV. [Injected non-absorbable fillers in large volumes]. [in Russian] Khirurgiia (Mosk). 2019;(4):42-51. doi:10.17116/hirurgia201904142, 10.17116/hirurgia201904142
- 4. Crocco E, Pascini M, Suzuki N, Alves R, Proença T, Lellis R. Minocycline for the treatment of cutaneous silicone granulomas: A case report. J Cosmet Laser Ther. 2016;18(1):48-9. doi: 10.3109/14764172.2015.1052514. Epub 2016 Jan 25.
- 5. Paul S, Goyal A, Duncan LM, Smith GP. Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline. Dermatol Ther. 2015 Mar-Apr;28(2):98-101. doi: 10.1111/dth.12204. Epub 2015
- Page navigation anchor for RE: Taking a Long-Term View of Body Sculpting ProductsRE: Taking a Long-Term View of Body Sculpting Products
Prosperi-Porta et al. and their cited references outline short- and intermediate-term toxicities of some body sculpting products.(1) Others report long-term histopathological reactions to injections of foreign substances.(2) Metabolic effects and their associations are also detailed as a more complete picture of such adversity unfolds.(3)
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One lesser studied but potentially serious consequence of such injections is the longer term effect on immune dysregulation, and thereafter autoimmunity, that can potentially arise with chronic exposure to foreign products.(4,5) An autoimmune/inflammatory syndrome has been linked to foreign materials that may create adjuvancy. Some of the clinical presentations may include atypical multiple sclerosis, arthritides, possible Sjogren’s syndrome, and antiphospholipid syndromes among others. The consequences of such immune dysregulation are often insidious in onset and confuse both patient and physician. Multiple body systems may be involved, and patients are often multi-doctored as consternation arises to define the entity or causation.(4) Infamous in this regard are silicone products, some implants of which have been associated with atypical lymphomas.(4) Variable dysautonomia and peripheral neuropathy can further add to the already complicated scenario.(5)
Mast cell activation may be linked to the above and create an allergic profile that at times may mimic mastocytosis. Such activation is usually polyclonal but in its chronic...Competing Interests: None declared.References
- 1. Prosperi-Porta G, Oleynick C, Vaughan S. Myositis from intramuscular oil injections in a bodybuilder. CMAJ 2020;192:E480.
- 2. AbdulGaffar B. Illicit injections in bodybuilders: a clinicopathological study of 11 cases in 9 patients with a spectrum of histological reaction patterns. Int J Surg Pathol 2014;22(8):688-94.
- 3. Eldrup E, Theilade S, Lorenzen M, et al. Hypercalcemia after cosmetic oil injections : unraveling etiology, pathogenesis, and severity. J Bone Miner Res 2020 Sep 15. doi : 10.1002/jbmr.4179.
- 4. Cimolai N. Mast cell biology and linkages for non-clonal mast cell activation syndrome and autoimmune/inflammatory syndrome induced by adjuvants. SN Comp Clin Med 2020 Oct. doi: 10.1007/s423399-020-00494-8.
- 5. Cimolai N. Mast cell biology in the context of dysautonomia and neuropathy. Clin Immunol 2020;215:108417.