Penile paraffinoma: self-injection with mineral oil

Two-Stage Penile Reconstruction after Paraffin Injection: A Case Report and a Systematic Review of the Literature

BACKGROUND

Penile injection of foreign materials is an obsolete practice often performed by non-medical personnel in order to enlarge penile size.

METHODS

A systematic review of the literature from 1956 to 2022 was conducted in accordance with the general guidelines recommended by the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We included full papers published from 1956 to 2022. We also described a case report of a 23 year old Bulgarian male affected by penile paraffinoma who underwent a 2-stages surgical technique.

RESULTS

A total of 152 cases have been reported, with a median age of 37.9 ranging from 18 to 64 years. Six different techniques have been described in the whole literature: bilateral scrotal flap, simple excision of the paraffinoma with primary closure, two-stage scrotum skin flap, medial prepuce-soprapubic advancement flap technique and penile reconstruction using split thickness skin graft (STSG) or full thickness skin graft (FTSG). An analysis of the distribution among early and late complications was then carried out.

CONCLUSION

In our experience, among the variety of surgical techniques described, a two-stage penile reconstruction using scrotal skin results in excellent cosmetic and functional outcomes, with a low rate of complications.

Aesthetic and Functional Results after Single- and Two-Stage Resection and Reconstruction of Penile Paraffinomas - Experience from Two Tertiary Centers and a Surgical Management Algorithm

The treatment of choice of penile paraffinoma (PP) is surgical resection. Penile soft tissue coverage in a combined Urology/Plastic Surgery procedure, is often needed.

OBJECTIVE

To describe the surgical techniques, aesthetics and functional outcomes, and to provide a practical algorithm for the surgical management of symptomatic PP.

METHODS

We retrospectively recruited PP patients treated with surgical resection, from 2004 to 2020, in the Reina Sofia Hospital of Murcia (Spain) and Sourasky Medical Center (Israel). Procedural and postoperative erectile function, according to the short version of the International Index of Erectile Function (IIEF-5) data were collected.

RESULTS

Eight patients underwent surgery. The mean age was 30 years. The mean time between substance injection and surgery was 6 years. The most frequently injected material was liquid paraffin (50%), followed by Vaseline. Extensive skin involvement was present in all patients with liquid paraffin, requiring 2-stage surgery or skin graft. PP surgical treatment was successfully achieved in an Urology/Plastic Surgery joined effort. Postoperative erectile function was preserved in all cases.

CONCLUSION

PP can pose a surgical challenge. A combined surgical approach with urology and plastics allows for functional and aesthetic preservation. The extent of PP and the viability of shaft skin preservation should guide surgical approach.

Complications Following Self-Administration of Hyaluronic Acid Fillers: Literature Review

The purpose of the present study is to review published literature regarding complications following self-administration of hyaluronic acid (HA) filler. The following keywords were searched in Pubmed and Cochrane database: filler AND self injection, hyaluronic acid AND self injection; filler AND self administration; hyaluronic acid AND self administration. Two authors performed title and abstract eligibility assessment independently. Gray literature and all articles cited in the included papers were also screened and their reference lists were examined to identify other potentially pertinent studies. Non-English papers were excluded. A total of 4 complications following self injection of HA were identified. Conversely, after performing a general search through the Google Internet search engine, with the item “self-injection of hyaluronic acid filler”, there were 604,000 hits. The number of articles reporting complications after the self administration of HA is few. Despite that internet searches on the same topic shows that self-administration of HA fillers is a widely discussed phenomenon in several on-line forums. The present review suggests that complications after self-injection of HA are an under-reported phenomenon.

Complications of penile self-injections: investigation of 680 patients with complications following penile self-injections with mineral oil

Objective

Penile implants and injection of foreign materials have been described in texts like Kama Sutra for more than 1500 years, and are still being practiced around the world. The extent of this practice is unknown, and the documentation available today only scratches the surface. This study investigates and documents the complications after penile self-injections at the Mae Tao Clinic. To our knowledge, this study represents the largest series of patients representing complications to penile self-injections.

Study design

Retrospective study.

Methods

We investigated data on 680 patients admitted with penile self-injections during a 5-year period. Data were studied for general patient data, symptoms, time of injection, and treatment.

Results

Age at admittance ranged from 17 to 68 with a mean age of 32 years. Time between injection and presentation was registered with a mean of 36.7 months, over half presented with complications within 1 year. Most frequent complications were penile pain (84%), swelling (82.5%), induration (42.9%), purulent secretion (21.8%), and ulceration (12.8%). Of the 680 patients, 507 (74.6%) underwent surgical treatment (503 excision and 4 circumcision), while 173 (25.4%) were treated conservatively.

Conclusion

Our data suggest that penile self-injections with mineral oil are more prevalent in certain areas than previously acknowledged. In 5 years, more than 680 patients presented with complications to penile self-injections, of which 75% needed surgical intervention, mainly in the form of radical excision of the lesions followed by skin grafting. Preventive measures to this physically and psychologically devastating problem are highly warranted.

Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction

A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review.

A case series and a review of the literature on foreign modelling agent reaction: an emerging problem

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

Magnetic resonance imaging of penile paraffinoma: case report

Background

Penile paraffinoma is a well-known delayed complication of paraffin oil injection into the penis for penile girth augmentation but its MRI features have not been previously described.

Case presentation

A 35-year-old Ukraine man presented with erectile dysfunction, voiding difficulty and an irregular, hard and painful penile mass that had progressively grown over the last year. He reported having received, seven years before, several penile injections of paraffin oil for penile girth augmentation. On physical examination, the mass was tender, poorly delimited, and involved the whole penile shaft and the cranial part of the scrotum. Preoperative MRI, performed to determine the extent of tissue to be removed and the possibilities of penile reconstruction, showed a newly-formed homogeneous tissue, compressing but not infiltrating Buck’s fascia, iso-hypointense relative to muscle on T1-weighted sequences, and with a low signal intensity at T2-weighted sequences. On T1-weighted fat suppressed sequences, it did not enhance with contrast administration. MRI data were confirmed by surgical findings, as the newly-formed scar tissue did not infiltrate Buck’s fascia. Pathology confirmed the diagnosis of penile paraffinoma.

Conclusion

MRI seems to provide an adequate imaging of the histological events occurring after injection of paraffin oil in the subcutaneous tissues. Penile paraffinoma remains a clinical diagnosis, but MRI features may be helpful in planning an adequate surgical strategy and, in selected cases, establishing the differential diagnosis with other penile diseases, including cancer.

An unusual delayed complication of paraffin self-injection for penile girth augmentation

Background

Penile self-injection of various oils is still carried out among Eastern Europe people for penile girth augmentation despite the potential destructive complications of this practice are well known. Penile reactions to such foreign bodies include scarring, abscess formation, ulceration, and even Fournier’s gangrene; voiding problems due to mineral oil self-injection have been reported only once. To our knowledge, we describe the first case of paraffin self-injection for penile girth augmentation presenting with acute urinary retention.

Case presentation

A 27-year-old Romanian man presented with severe penile pain and acute urinary retention five years after having practiced repeated penile self-injections of paraffin for penile girth augmentation. The penile shaft was massively enlarged, fibrotic and phymotic; urethral catheterization failed due to severe stricture of the proximal pendulum urethra. The patients refused placement of a suprapubic catheter and underwent immediate penile surgical exploration. The scarred tissue between dartos and Buck’s fascia and a fibrotic ring occluding the urethra were removed and the penile skin reconstructed. Pathology confirmed the diagnosis of paraffinoma. The patient resumed normal voiding immediately after catheter removal on second postoperative day; he was very pleased with cosmetic, sexual and voiding results at six weeks, six months and 1 year follow-up.

Conclusions

The present report describes a novel complication of penile self-injection for penile girth augmentation. Because of the increasing number of patients seeking penile augmentation, physicians dealing with sexual medicine should pay more attention to such request to prevent the use of non medical treatments that can turn into medical disasters.

New reconstructive surgery for penile paraffinoma to prevent necrosis of ventral penile skin

OBJECTIVE

To introduce a new repair technique, inverted V-shape, for penile paraffinoma without necrosis of the ventral skin anastomosed.

MATERIALS AND METHODS

From March 2006 to July 2012, 34 patients underwent penile paraffinoma repair using the T-style or a new operation procedure, the inverted V-shape anastomosis with a bilateral scrotal flap. The patients were subdivided into 2 groups. In group 1, each patient underwent the T-style anastomosis. In group 2, each patient underwent the inverted V-shape anastomosis. Two circumferential incisions were made, one at the skin just proximal to the corona of the penis and one at the penoscrotal junction. Complete removal of the involved skin and subcutaneous tissue, including paraffinoma, was performed. Both scrotal flaps were drawn to the mid-dorsal portion of the corona after scrotal flaps were incised appropriately and sutured with a T-style anastomosis between the coronal and scrotal flaps. The ventral skin was anastomosed end to end to avoid the T-style anastomosis, similar to a dorsal anastomosis. We created an inverted V incision 1 cm below from the anastomosis site. The scrotal flaps were sutured layer by layer.

RESULTS

All 14 flaps survived completely without the necrosis of the ventral skin. The results were successful and without any major complications.

CONCLUSION

Penile resurfacing without the T-style anastomosis at the ventral corona with bilateral scrotal flaps is a new technique for repair of penile paraffinoma. It is an effective and reliable method, especially for the saving corona and scrotal flap anastomosed to the ventral penile body.

Surgical solutions for the complications of the Vaseline self-injection of the penis

INTRODUCTION

Penile girth enhancement by the injection of Vaseline is an existing practice. Many cases develop severe complications that need surgery.

AIM

To report on the reconstructive surgical solutions of the complications of Vaseline self-injection and the outcomes. To develop a modification of a one-step reconstruction method involving the use of pedicled scrotal flaps.

MAIN OUTCOME MEASURES

The complications and their surgical solutions were classified as regards severity and difficulty. The outcomes were observed and a newly introduced one-step surgical method was investigated.

METHODS

Seventy-eight consecutive patients (87.2% of them with a history of imprisonment) were divided into three groups. In group A, aesthetic penile defects or phimosis caused by the Vaseline necessitated circumcision or local excision. In group B, the whole penile skin was involved, and total skin removal and two- or (a newly modified) one-step reconstructive surgery were performed. In group C, both the whole penile skin and the scrotum were involved: complete skin removal and skin grafting or skin pedicled flap transplantation were carried out.

RESULTS

In five cases in group B, postoperative skin necrosis made a second operation necessary. There was one intraoperative urethral injury, where a urethral fistula developed and a second urethral reconstruction was performed. There was no major complication with the newly developed one-stage pedicled flap procedure. At the end of the therapy, all the cases were healed. All of the patients reported successful sexual intercourse after the operations and 91% were satisfied with the result.

CONCLUSIONS

The complications depend mainly on the amount of Vaseline injected, the hygienic circumstances, and the personal tolerability. In the worst cases, only radical skin removal and skin transplantation can solve the problem. The newly developed one-step arterial branch-preserving scrotal skin flap reconstruction appears to be a suitable and cost-effective solution for these patients.

Intravesical Foreign Body via a Vesicoperineal Fistula

Male urethral “play” has been described for centuries. There are serious potential complications in this. We present a bizarre case of a variant of such play. A 49-year-old man presented with abdominal pain and incontinence. He had created a “neovagina” at the perineum for self-pleasure. The handle of a toilet brush was placed in the neovagina for self-pleasure but retracted into the bladder via a vesicoperineal fistula. An open cystotomy was performed to remove the foreign body.

Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia

Chronic granulomatous inflammation may develop after injecting foreign oily substances into the penis. The disorder affects mainly the site of administration, but regional lymphadenopathy or even systemic disease can occur. We present a 39-year-old man with petroleum jelly-induced penile lesion and unilateral inguinal lymphadenitis mimicking incarcerated inguinal hernia. At hernioplasty no hernial sac was found, but enlarged lymph nodes suspicious for malignancy were identified. The histopathologic findings of these nodes were consistent with mineral oil granuloma. Paraffinoma of the male genitalia can cause various clinical features posing a differential diagnostic dilemma. Regional lymphadenitis may be the main clinical characteristic. Patient's history, physical and histopathological examination are required to establish the diagnosis.

Penile paraffinoma

Penile paraffinoma is an uncommon entity produced by penile paraffin injections for the purpose of penile enlargement by a nonmedical person. Although it is not a current method of penile enlargement procedures, in our opinion dermatologists and urology specialist should be have knowledge of this entity about diagnosis and management. It will be an aim to share our experiences and views in this paper.

Hungarian "jailhouse rock": incidence and morbidity of Vaseline self-injection of the penis

INTRODUCTION

Vaseline self-injection into the penis is currently a popular procedure in prisons. Since such injections are illegal, severe complications of the procedure can often remain hidden.

AIM

To identify the incidence, motivation, and morbidity of Vaseline self-injection into the penis among inmates.

METHODS

A total of 4,735 inmates at the largest Hungarian prisons were asked to complete a questionnaire relating to their sexual life, whether they had self-injected Vaseline into their penis, the motivation leading them to resort to Vaseline self-injection, any complications observed and the level of satisfaction attained.

MAIN OUTCOME MEASURES

A 17-point questionnaire on the circumstances, motivations, and complications of Vaseline self-injection among prisoners.

RESULTS

Of the 1,905 responders, 15.7% admitted Vaseline self-injection. Only around one-fifth of the Vaseline injected subjects had not been satisfied with the original size of their penis and their sexual life up to the time of the injection, a proportion similar to that among Vaseline nonusers. While the satisfaction with the sexual life became significantly worse after the Vaseline injection, the satisfaction with the penis size did not change and an erectile dysfunction developed de novo in 21.4% of cases. The most common motivation for self-injection was a recommendation by another inmate; it was rarely recommended by a sexual partner. Complications had developed among 25.4% of the Vaseline users and 50.3% of them were not satisfied with the result of the Vaseline injection. Of the Vaseline users, 22.4% regretted the self-injection, while the rate among those who had developed complications was 53%.

CONCLUSIONS

The self-injection of Vaseline into the penile skin proved to be somewhat of a trend among these inmates. The complications depended mainly on the amount of Vaseline injected, the poor hygienic circumstances, and the personal tolerability. Increased awareness is needed for the prevention of this social, psychological, and physical problem.

Cross-sectional study examining four types of male penile and urethral "play"

OBJECTIVES

To provide further quantitative and qualitative evidence about men who insert foreign liquids and objects into their penis and/or urethra.

METHODS

As part of a larger, cross-sectional study examining men (n = 445) with genital piercings (GP), 2 questions inquired whether the respondents had penile tattoos and/or inserted other materials, such as fluids and foreign objects, into their penis and urethra.

RESULTS

Four different practices have been described in the literature: embedding (a) foreign objects and/or (b) liquids subcutaneously into penile tissue, as well as inserting (c) liquids and/or (d) foreign objects into the urethra. In our study, 354 (78%) men with GP responded to the 2 questions; 85 (24%) replied affirmatively and 68 (80%) provided comments. Respondents coined their practices penile and/or urethral "play." Two respondents embedded metal balls into their penis, 1 at age 13 injected water for penis enlargement; 11 inserted liquids into the urethra, and 63 reported insertion of 32 different objects, frequently urethral sounds or "sounding" (n = 33/52%) were mentioned. Major motivation themes focused on sexual stimulation and experimentation. Penile tattoos (n = 14) were also reported, mainly for esthetics. Few complications or STDs were reported.

CONCLUSIONS

Basic demographic assumptions of those who participate in these actions were challenged, and this study provides evidence of a wider distribution of men using penile or urethral play, and "sounding." Clinician awareness of these practices are important to obtain accurate health histories, manage genitourinary tract complications, as well as provide applicable patient education.

Complications after self-injection of hyaluronic acid and phosphatidylcholine for aesthetic purposes

Various types of dermal fillers have been developed for soft tissue augmentation, including hyaluronic acid products, which have been approved by regulatory agencies in Europe, the United States, and elsewhere. Phosphatidylcholine (PPC) injection has attracted attention for its application in the treatment of cellulite, weight loss, and skin rejuvenation. Because the public can now buy PPC and similar products from various online pharmacy websites without the involvement of a clinician, there is potential for misuse. The authors discuss two cases of complications experienced by patients after self-injection of hyaluronic acid and PPC for aesthetic purposes.

Paraffinoma

The subcutaneous infiltration of liquid paraffin is still used for penile enlargement. The procedure has many complications. A late problem is the development of foreign body granulomas known as paraffinomnas. They may be necrotic and ulcerated, requiring acute, radical surgical excision.

Subcutaneous cod liver oil injection for penile augmentation: review of literature and report of eight cases

OBJECTIVES

To study the presentations and treatment outcome of 8 consecutive patients for whom cod liver oil was injected in the subcutaneous area of their penises by a lay person for purpose of augmentation.

METHODS

Various amounts of cod liver oil were injected in the subcutaneous area of the penis of 8 low socioeconomic class patients by a nonmedical person. They presented by various complications ranging from paraphimosis up to abscess formation and necrosis of penile skin. All the patients underwent emergency initial surgical intervention ranging from dorsal preputial slit to skin debridement. Definitive surgical treatment was carried out using local penile flap and V-Y plasty.

RESULTS

The severity of complications was correlated to the amount of oil injected and the time interval between injections and presentation. All the 8 patients were cured after different staged surgical procedures. The postoperative course was uneventful in 6 patients, and 2 patients suffered from wound infection after the secondary treatment. All patients had acceptable cosmetic and functional outcome, and were satisfied regarding the length of the penis. None reported erectile dysfunction.

CONCLUSIONS

Increased public awareness is indicated to avoid this problem. Early detection and prompt treatment give acceptable anatomic and functional results.

Delayed complications of gel injection for penile girth augmentation

INTRODUCTION

Penile girth augmentation is a domain of extensive controversy and debate. A variety of methods is available for the choice of the surgeon including dermal-fat grafts and flaps. The need for a simple procedure with minimal donor site has lead to proposing injection therapy for penile augmentation, whether by fat or synthetic materials.

AIM

This work reports on a male patient suffering a deforming subcutaneous mass in the penis following penile girth augmentation by injection therapy using synthetic material, and describes its management, and pathologic analysis of the extracted tissue.

METHODS

The mass was excised through a circumferential subcoronal incision while maintaining skin vascularity and integrity of the corpora. The excised tissue was microscopically examined.

MAIN OUTCOME MEASURES

Cosmetic and functional results of surgical correction.

RESULTS

Cosmetic and functional outcome were acceptable. Pathology examination revealed features of foreign body granuloma.

CONCLUSION

Injection of fillers for girth augmentation of the penile shaft may result in delayed complications including migration, granulomatous reaction, and resorption that may occur beyond the follow-up span of the currently available study that recommends its use.

Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report

Background

Self-induced injections of liquid substances mainly for penis enlargement is a well-documented but still rather uncommon practice in the western world.

Case presentation

Herein we present the case of a 30-year-old male who self-inflicted, twice in a six-month-period, intra-urethral liquid paraffin and tied up his penis with a cord in order to achieve both enlargement and elongation. He arrived in our emergency department suffering from suprapubic pain; physical examination revealed a rather unique deformity of the penis. He finally refused any treatment and absconded.

Conclusion

Side effects after paraffin administration are various and sometimes severe. Most of the times surgical treatment is needed and radical excision together with follow-up seems the best modality. Such practices emphasize on the public's misbelieves and that some aspects of sexual medicine are yet covered with the veil of misconception.

Penile injection with silicone: case report and review of the literature

INTRODUCTION

Liquid injectable silicone (LIS) has been used for soft tissue augmentation in excess of 50 years. Until recently, all literature on penile augmentation with LIS consisted of case reports or small cases series, most involving surgical intervention to correct the complications of LIS. New formulations of LIS and new methodologies for injection have renewed interest in this procedure.

AIM

We reported a case of penile augmentation with LIS and reviewed the pertinent literature.

METHODS

Comprehensive literature review was performed using PubMed. We performed additional searches based on references from relevant review articles.

RESULTS

Injection of medical grade silicone for soft tissue augmentation has a role in carefully controlled study settings. Historically, the use of LIS for penile augmentation has had poor outcomes and required surgical intervention to correct complications resulting from LIS.

CONCLUSIONS

We currently discourage the use of LIS for penile augmentation until carefully designed and evaluated trials have been completed.

Foreign-body granuloma of the penis in sexually active individuals (penile paraffinoma)

BACKGROUND

The practice of insertion of foreign bodies in the penis is well documented, but the clinical characteristics of penile foreign-body granuloma (FBG) and social motivation of the patients has not been studied in large groups.

OBJECTIVE

The aim of this study was to evaluate the clinical and epidemiological profile of patients with penile insertion of foreign bodies and assess the significance of social motivation.

METHODS

Twenty-five heterosexual male patients, who visited our clinic from 1990 to 2005, were retrospectively studied. All of them had implanted two different types of foreign bodies in their penis and had tattoos in the same area. Twenty-five male patients with genital tattoos served as clinical controls.

RESULTS

The age of peak incidence of patients with penile FBG was 28 years. The youngest patient was 19 years. Twenty-three (23 of 25, 92%) of the patients were from gipsy origin, and two men were of Bulgarian origin. All the patients had risky social behaviour (prisoners and beggars). The motivation of 20 (20 of 25, 80%) of the patients was to enlarge the penile size. Fifteen (15 of 25, 60%) wanted to increase the feelings of the sexual partners. The majority of the patients (23 of 25, 92%) had injection of fatty substances, and 2 (2 of 25, 8%) had undergone implantation of a plastic pellet. In 14 cases (14 of 25, 56%), the insertion of mineral oil was complicated by formation of fistulas and wide ulcers with histological features of FBG.

CONCLUSION

The reported cases represent an example of the detrimental effects of the insertion of foreign bodies in the penis. Immediate measurements should be performed to prevent severe outcomes.

Penile paraffinoma: the delayed presentation

The injection of foreign substances into the penis for the purpose of augmentation may result in erectile dysfunction, voiding difficulties, and severe deformity. We report a case of penile paraffinoma in a 71-year-old man that developed nearly 40 years after undergoing a series of penile injections with an unknown substance. Penile paraffinoma can therefore present a diagnostic dilemma given its protracted latency period, after which time the initial injections have faded into distant memory.

An unusual case of self-injected bovine fat in liquid form to the face for cosmetic reasons

A 45-year-old woman injected bovine fat in liquid form in to her periorbital area and nasolabial folds near the lip margin and glabellar area to look younger. She was influenced by a TV program about fat augmentation of the aging face and collagen injection to the wrinkles. Major depression had been diagnosed for this woman 5 years previously, after which she used antidepressants and hypnotics irregularly. The prolonged edema of her face subsided within 3 months, along with the erythema, itching, and firmness at the injection sites. No liposuction of the injected material was planned because it had changed to solid form as soon as it was injected. Additionally, it was thought that surgical excision of the fat would not be effective and could harm the facial nerve branches because magnetic resonance imaging showed diffuse enlargement of subcutaneous tissue. Therefore, a conservative approach, such as medical treatment with close follow-up evaluation was preferred. The reported case is presented not only to add an interesting self-injection case to the literature, but also to show that patients with psychological problems may harm themselves by using inappropriate methods for cosmetic reasons under the effect of inaccurate information obtained from TV programs, press, family, and friends.

Cellular immunodeficiency and autoimmunity in long-term mineral oil administration

BACKGROUND

Subcutaneous mineral oil injection is an old-fashioned practice used mostly for cosmetic purposes. Infection, ulceration, subcutaneous nodules, and autoimmune activation are among the known adverse effects. Immunodeficiency has not been previously reported in association with mineral oil injection.

OBJECTIVE

To report the case of a 43-year-old woman who performed long-term self-administration of mineral oil and was found to have both cellular immunodeficiency and autoimmunity.

METHODS

We performed an immunological evaluation. Throat, induced sputum, urine, and blood cultures were examined for microorganisms. Pelvic computed tomography, inguinal lymph node biopsy, bone marrow biopsy, and liver biopsy were also performed.

RESULTS

Laboratory results revealed peripheral lymphopenia, very low absolute numbers of lymphocyte subpopulations, and a markedly impaired lymphocyte proliferative response to mitogens (phytohemagglutinin and concanavalin A) and recall antigens (mumps, Candida albicans, purified protein derivative, and tetanus toxoid). The cultures were negative for microorganisms. The pelvic computed tomogram demonstrated areas of diffuse oil-density signals throughout the subcutaneous tissue in the gluteal area and proximal lower extremities, as well as bilateral inguinal lymphadenopathy. A lymph node biopsy specimen showed lipid granulomas and necrotizing lymphadenitis. A bone marrow biopsy specimen demonstrated hypercellular marrow with normal trilineage hematopoesis. Increased serum transaminase levels, hypoalbuminemia, positive anti-extractable nuclear antigen and anti-Ro antibodies, and plasma cells in the liver suggested an autoimmune process.

CONCLUSIONS

Mineral oil administration may be associated with both cellular immunodeficiency and autoimmunity. Patients who have received long-term administration of a foreign substance should undergo a comprehensive immunological evaluation.

Penile paraffinoma

A 40-year-old Caucasian man, originating from Ukraine, but living for the last year and a half in Portugal, presented to our department with a one year history of an irregular penile mass and phimosis. He reluctantly admitted that 8 years previously he had multiple mineral oil injections in the penis, for the purpose of penile enlargement. A diagnosis of penile paraffinoma was made and surgical excision was performed at the urology department. Paraffinoma results from mineral-oil injections: such practice is very rare in the western world nowadays, however, it still is performed in many Eastern European Countries.