Migrating granulomatous chronic reaction from hyaluronic acid skin filler (Restylane): Review and histopathological study with histochemical Stainings

Rossana Cecchi, Andrea Spota, Paola Frati, Barbara Muciaccia

Research output: Contribution to journalArticle

Abstract

Background: A unique case is presented in whom an allergic reaction to Restylane filler, associated with migrating granulomas, persisted despite medical interventions. A histopathological study was requested for evidence at court. Methods: Hematoxylin-eosin, alcian blue and colloidal iron staining were applied to skin sample biopsies obtained 5 months and 3 years after the hyaluronic acid (HA) injection. Results: The histological staining highlighted the presence of the filler inside the foreign body granuloma and in the derma of a biopsy obtained after 5 months; a small amount of filler was discovered within a granulomatous reaction 3 years after the injection. Conclusions: Smaller fragments of HA display inflammatory, angiogenic and immune-stimulatory activities. Intradermal skin testing before the start of HA filler therapy, and before each subsequent injection, may prevent legal implications for the plastic surgeon. Informed consent to skin tests should be obtained.

Original languageEnglish
Pages (from-to)14-17
Number of pages4
JournalDermatology
Volume228
Issue number1
DOIs
Publication statusPublished - Feb 2014

Keywords

  • Filler
  • Histochemistry
  • Histopathology
  • Hyaluronic acid
  • Informed consent
  • Migrating chronic granuloma

ASJC Scopus subject areas

  • Dermatology

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