Comment on Grippaudo et al.: Radiolabelled white blood cell scintigraphy in the work-up of dermal filler complications

Abstract

Dear Sir, I read with great interest the recent article by Grippaudo et al. [1]. The authors evaluated the role of WBC scintigraphy in the diagnosis and follow-up of patients with suspected soft tissue infection caused by dermal fillers in the face. They concluded that scintigraphy with radiolabelled WBC was found to be the most accurate method for diagnosing infection in patients with long-term dermal filler complications, particularly using qualitative analysis of single photon emission computed tomography (SPECT) images. I think infection should be classified as an acute or subacute complication related to dermal fillers. Rather, foreign body granuloma is a delayed or long-term dermal filler complication [2, 3]. Therefore, it is reasonable to say that infection can be accompanied by a granulomatous reaction. Although accurate diagnosis has been made using scintigraphy with radiolabelled WBC, this novel method cannot affect the treatment modality. Clinically, once physicians suspect filler-related infection, they should commence adequate culture followed by appropriate antibiotic therapy [4, 5]. In my opinion, it would be more practical if clinicians could exclude soft tissue tumour in the cases of foreign body granuloma by use of scintigraphy with radiolabelled WBC. Diagnosis of dermal filler-related infection with such a novel method is less cost-effective. In addition, depending on such a novel method for follow-up of patients with suspected soft tissue infection caused by dermal fillers cannot be justified in all cases. I think scintigraphy with radiolabelled WBC only reveals inflammatory reactions without providing additional information about the injected materials or otherwise while incurring additional costs to the patients. Due to its cost-effectiveness, surgeons have ceased to conduct a routine diagnostic imaging study once clinical diagnoses are confirmed. In my opinion, clinical challenges originate not from an insufficient diagnostic method but mainly from the difficulty in obtaining an accurate history. Above all, accurate diagnosis based on clinical suspicion is the most important to define treatment [4]. However, as dermal filler injections have become widespread and subsequent infection/inflammation or granuloma have increased, I agree with Grippaudo et al. that physicians treating these complicated conditions should be familiar with the novel diagnostic method [1]. With various dermal fillers, attempts to rejuvenate the aging hands also have recently gained popularity [5]. I suggest that further study with complications of hand rejuvenation can also be of great interest to many clinicians with the novel method introduced by the authors. To the best of our knowledge, the article by Grippaudo et al. is the first study to introduce scintigraphy with radiolabelled WBC for the diagnosis and follow-up of injected filler complications. This issue itself has special merit to many surgeons as well as other physicians treating this complicated condition and further studies with granulomatous lesions caused by dermal filler are warranted.