Collagens
Bovine collagen can be immunogenic and cause a foreign body granulomatous reaction at the rate of 1.3%.Erythematous, indurated reactions or subcutaneous papules have been reported as early as 10 days after the first injection.About 1-3% of patients with one negative skin test may still develop a reaction to the filler. Consequently, two pre-treatment skin tests are recommended 3-4 weeks apart to make sure that the patient is not allergic to bovine collagen. It responds well to a short-term course of oral glucocorticoid therapy but treatment is not always necessary as it may be self-limiting.
Hyaluronic Acid Fillers
Granulomatous foreign body reaction can develop months to years after the injection. This reaction may be asymptomatic or have associated erythema and swelling. Histologically, a collection of macrophages with some multinucleated giant cells and surrounding lymphocytes are seen.Persistent granulomatous foreign body reactions can be treated with intralesional corticosteroid injections. The usual dosage would be 5-10 mg/cc depending on the severity of the reaction and should be repeated if necessary 4-6 weeks later. Some authors have advocated the use of hyalorunidase hoping that the break-down of the product would stop the foreign body reaction.
Poly-l-lactic Acid
In the US clinical studies, skin nodules have been described in HIV-infected individuals and occur on average 3-4 months post-treatment, but can occur as early as 1 month after the injections. The nodules are typically palpable, asymptomatic and non-visible and occur in up to 13% of patients in the American HIV lipoatrophy studies. The exact nature and mechanism for these nodules is not known but experience has shown that injections should be made below the dermis to avoid their detection.
Edit By:Bella
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