Abstract
Injection of filler material has become routine in dermatology in improving the appearance of rhytides and increasing skin volume associated with aging. While the vast majority of injections are accomplished without complications, foreign body reactions may develop in a certain percentage of individuals. We recently encountered a 65-year-old woman with recurrent malignant melanoma who presented with marked thickening along the sides of her face for approximately 2 months. She recently received nivolumab infusions for recurrent malignant melanoma and noted that symptoms worsened after each infusion. She reported having had cosmetic procedures done three years prior, one of which was an injection of a long-lasting dermal filler, polymethylmethacrylate microsphere enhanced bovine collagen (Bellafill). A biopsy of two areas revealed nodular infiltrates of histiocytes with small round lobules recognizable as polymethylmethacrylate microspheres. Based on clinical and histopathologic findings, a diagnosis of granulomatous dermatitis filler reaction was rendered. Nivolumab is a PD-1 checkpoint inhibitor that disrupts T-cell inhibitory pathways leading to increased immune activation. In this case, the immune activation triggered a florid granulomatous reaction to the filler the patient had been injected with 3 years previously. We present this case as the second report of this phenomenon and the first in the dermatologic literature. This is a newly recognized side effect of PD-1 checkpoint immunotherapy and patients who are about to initiate such therapy who have had filler injections should be warned about this potential complication.
Highlights
Dermal filler injections have grown rapidly in popularity over the last decade
While the vast majority of these injections are accomplished without complication, foreign body reactions may develop in 0.04%-0.3% of bovine collagen injection cases
Nivolumab is a human immunoglobulin G4 (IgG4) that is approved by the Food and Drug Administration (FDA) for treatment of various cancers including advanced melanoma.[4]
Summary
Dermal filler injections have grown rapidly in popularity over the last decade They provide an effective way of improving the appearance of individuals with rhytides and tissue loss secondary to skin aging.[2,3] While the vast majority of these injections are accomplished without complication, foreign body reactions may develop in 0.04%-0.3% of bovine collagen injection cases. Upon further questioning, she reported undergoing cosmetic procedures one year prior, one of which was a dermal filler injection, Bellafill, comprised of bovine collagen with non-resorbable polymethylmethacrylate microspheres. She reported undergoing cosmetic procedures one year prior, one of which was a dermal filler injection, Bellafill, comprised of bovine collagen with non-resorbable polymethylmethacrylate microspheres She did not have any skin testing prior to these procedures and experienced no adverse reactions at the time. After clearance from her oncologist, she underwent 2 botulinum toxin injections for her rhytides (at her request), which resulted in no adverse reactions
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