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Cosio T, Costanza G, Coniglione F, Romeo A, Iacovelli F, Diluvio L, Dika E, Shumak RG, Rossi P, Bianchi L, Falconi M, Campione E. From In Silico Simulation between TGF- β Receptors and Quercetin to Clinical Insight of a Medical Device Containing Allium cepa: Its Efficacy and Tolerability on Post-Surgical Scars. Life (Basel) 2023; 13:1781. [PMID: 37629638 PMCID: PMC10455185 DOI: 10.3390/life13081781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Objective: Keloid and hypertrophic scars are a challenge in clinical management, causing functional and psychological discomfort. These pathological scars are caused by a proliferation of dermal tissue following skin injury. The TGF-β/Smad signal pathway in the fibroblasts and myofibroblasts is involved in the scarring process of skin fibrosis. Today, multiple therapeutic strategies that target the TGF-β/Smad signal pathway are evaluated to attenuate aberrant skin scars that are sometimes difficult to manage. We performed a head-to-head, randomized controlled trial evaluating the appearance of the post-surgical scars of 64 subjects after two times daily topical application to compare the effect of a class I pullulan-based medical device containing Allium cepa extract 5% and hyaluronic acid 5% gel versus a class I medical device silicone gel on new post-surgical wounds. (2) Methods: Objective scar assessment using the Vancouver Scar Scale (VSS), POSAS, and other scales were performed after 4, 8, and 12 weeks of treatment and statistical analyses were performed. The trial was registered in clinicalTrials.gov ( NCT05412745). In parallel, molecular docking simulations have been performed to investigate the role of Allium cepa in TGF-β/Smad signal pathway. (3) Results: We showed that VSS, POSAS scale, itching, and redness reduced significantly at week 4 and 8 in the subjects using devices containing Allium cepa and HA. No statistically significant differences in evaluated scores were noted at 12 weeks of treatment. Safety was also evaluated by gathering adverse events related to the application of the gel. Subject compliance and safety with the assigned gel were similar between the two study groups. Molecular docking simulations have shown how Allium cepa could inhibit fibroblasts proliferation and contraction via TGF-β/Smad signal pathway. (4) Conclusions: The topical application of a pullulan-based medical device containing Allium cepa and HA showed a clear reduction in the local inflammation, which might lead to a reduced probability of developing hypertrophic scars or keloids.
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Affiliation(s)
- Terenzio Cosio
- Post Graduate School of Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.D.); (R.G.S.); (L.B.)
| | - Gaetana Costanza
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.D.); (R.G.S.); (L.B.)
- Virology Unit, Tor Vergata Hospital, 00133 Rome, Italy
| | - Filadelfo Coniglione
- Department of Surgical Sciences, University Nostra Signora del Buon Consiglio, 1000 Tirana, Albania;
| | - Alice Romeo
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (A.R.); (F.I.); (M.F.)
| | - Federico Iacovelli
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (A.R.); (F.I.); (M.F.)
| | - Laura Diluvio
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.D.); (R.G.S.); (L.B.)
| | - Emi Dika
- Dermatology, Department of Medical and Surgical Sciences Alma Mater Studiorum, University of Bologna, 40138 Bolog, Italy;
- Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Ruslana Gaeta Shumak
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.D.); (R.G.S.); (L.B.)
| | - Piero Rossi
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy;
- Minimally Invasive Unit, Tor Vergata Hospital, 00133 Rome, Italy
| | - Luca Bianchi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.D.); (R.G.S.); (L.B.)
| | - Mattia Falconi
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy; (A.R.); (F.I.); (M.F.)
| | - Elena Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.D.); (R.G.S.); (L.B.)
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Abtahi-Naeini B, Rastegarnasab F, Saffaei A. Liquid vitamin E injection for cosmetic facial rejuvenation: A disaster report of lipogranuloma. J Cosmet Dermatol 2022; 21:5549-5554. [PMID: 35947509 DOI: 10.1111/jocd.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The use of vitamin E for Facial rejuvenation is a dangerous practice and is associated with potential local, and sometimes systemic and life-threatening complications. Clinicians should be aware of complications induced by the injection of illegal products for tissue augmentation. Also, regulatory organizations should monitor illegal beauty centers and enact restrictive laws. CASE PRESENTATION Herein, we report a case of liquid vitamin E injection for cosmetic facial rejuvenation and development of facial persistent erythema and induration, treated with oral prednisolone, azathioprine, and minocycline. Also, we review the reported cases of vitamin E injection for cosmetic facial rejuvenation. CONCLUSION Lipogranuloma is one of those complications of vitamin E injection for cosmetic rejuvenation. It mostly represents inflammation, edema, erythema, and tenderness. Since there was no standard treatment for this complication, the management of these patients is challenging. Patients who have undergone cosmetic interventions in illegal institutions are more likely to develop such complications including medical and psychological problems. Clinicians should be aware of these complications for the best diagnosis and treatment.
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Affiliation(s)
- Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ali Saffaei
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lethal silicone embolization syndrome complicating penile, scrotal and breast self-augmentation. Forensic Sci Med Pathol 2018; 15:304-308. [DOI: 10.1007/s12024-018-0064-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
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Wang LL, Thomas WW, Friedman O. Granuloma formation secondary to silicone injection for soft-tissue augmentation in facial cosmetics: Mechanisms and literature review. EAR, NOSE & THROAT JOURNAL 2018; 97:E46-E51. [PMID: 29493732 DOI: 10.1177/0145561318097001-211] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The use of injectable fillers is increasingly popular as an alternative to surgery for facial cosmetic applications. In this regard, silicone is a versatile biomaterial filler that has been used for these purposes, but its use warrants further investigation, especially since it is not clinically approved for such uses. We describe the use of silicone as a facial injectable filler through a scholarly review of the literature for cases of silicone granuloma formation published from September 2007 through September 2017, and we present various contexts in which this complication has been observed. We further review the immunologic etiology of granuloma formation and other complications of silicone injections. We write this report to caution physicians on the use of silicone fillers which, for all their advantages, are associated with significant long-term risks that are frequently overlooked.
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Affiliation(s)
- Leo L Wang
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
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Sarac G, Kapicioglu Y, Sener S, Cenk H, Akatli A. Management of complications of vitamin E injections into the face. Dermatol Ther 2018; 31:e12621. [PMID: 30133797 DOI: 10.1111/dth.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Gulbahar Sarac
- Department of Dermatology, Faculty of Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - Yelda Kapicioglu
- Department of Dermatology, Faculty of Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - Serpil Sener
- Department of Dermatology, Faculty of Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - Hulya Cenk
- Department of Dermatology, Malatya Training and Reseach Hospital, Malatya, Turkey
| | - Aysenur Akatli
- Department of Pathology, Faculty of Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
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Penile Paraffinoma: Should We Perform Ultrasound? ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Morales-Raya C, Calleja-Algarra A, Tous-Romero F, Rivera-Díaz R. Parafinoma de pene: ¿le hacemos una ecografía? ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:478-480. [DOI: 10.1016/j.ad.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/25/2016] [Accepted: 11/17/2016] [Indexed: 12/01/2022] Open
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Singh GKS, Turner L, Desai R, Jimenez M, Handelsman DJ. Pharmacokinetic-pharmacodynamic study of subcutaneous injection of depot nandrolone decanoate using dried blood spots sampling coupled with ultrapressure liquid chromatography tandem mass spectrometry assays. J Clin Endocrinol Metab 2014; 99:2592-8. [PMID: 24684468 DOI: 10.1210/jc.2014-1243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Testosterone (T) and nandrolone (N) esters require deep im injections by medical personnel but these often deposit injectate into sc fat so that more convenient sc self-administration may be feasible. OBJECTIVE To investigate the feasibility and pharmacology of sc injection of N decanoate in healthy men using dried blood spot (DBS) for frequent blood sampling without clinic visits. SETTING AND DESIGN Healthy male volunteers received 100 mg N decanoate by a single sc injection. Finger-prick capillary blood was spotted onto filter paper before injection daily at home for 21 d and stored at room temperature. Venous whole blood was also spotted onto filter paper before and weekly for 3 wk after injection. DBS were extracted for assay of N and T by liquid chromatography tandem mass spectrometry in a single batch with serum concentrations estimated with adjustment for capillary blood sample volume and hematocrit to define peak (N) or nadir (T) time and concentration from individual daily measurements. RESULTS Daily serum N peaked 2.50 ± 0.25 (SEM) ng/mL at a median (range) of 6 (4-13) days causing a reduction in serum T from 3.50 ± 0.57 ng/mL at baseline to a nadir of 0.38 ± 0.13 (SEM) ng/mL (89 ± 3% suppression) at a median (range) of 8 (5-16) days. Simultaneously sampled capillary, venous whole blood, and serum gave almost identical results for serum T and N. Finger-pricks and sc injections were well tolerated. CONCLUSIONS This study demonstrates that A) DBS sampling with liquid chromatography mass spectrometry steroid analysis achieves frequent time sampling in the community without requiring clinic visits, venesection, or frozen serum storage, and B) androgen esters in an oil vehicle can be delivered effectively by sc injection, thus avoiding the need for medically supervised deep-im injections.
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Affiliation(s)
- Gurmeet K S Singh
- Andrology Department (G.K.S.S., L.T., M.J., D.J.H.), Concord Hospital, Sydney, New South Wales 2139, Australia; Faculty of Pharmacy (G.K.S.S.), Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, 42300 Malaysia; and ANZAC Research Institute (G.K.S.S., R.D., M.J., D.J.H.), University of Sydney, Sydney New South Wales 2139, Australia
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Visnyei K, Samuel M, Heacock L, Cortes JA. Hypercalcemia in a male-to-female transgender patient after body contouring injections: a case report. J Med Case Rep 2014; 8:71. [PMID: 24572248 PMCID: PMC3976093 DOI: 10.1186/1752-1947-8-71] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Body contouring injections by non-licensed providers are frequently sought out by a subset of the male-to-female transgender community. Although short-term side effects such as pulmonary embolism and injection site infection are well known, long-term consequences of such practices are less well studied. CASE PRESENTATION Here we describe the case of a 40-year-old African American male-to-female transgender patient who presented to our institution with hypercalcemia and acute renal failure secondary to body contouring injections with industrial strength silicone by non-licensed providers, a decade prior to her visit. Work-up revealed an extensive granulomatous inflammatory process in the injection area resulting in electrolyte abnormalities and kidney injury. The patient's lab results and symptoms responded well to long-term corticosteroid treatment and correlated with treatment adherence. CONCLUSION Affected patients can sometimes present with unusual clinical symptoms many years after silicone injections. In a constantly growing transgender community that often utilizes non-licensed providers for silicone injections, the medical community will likely face an increasing number of patients with long-term side effects of such practices. Therefore, it is imperative for physicians to recognize such cases promptly and initiate potentially life-saving treatment.
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Affiliation(s)
- Koppany Visnyei
- Department of Internal Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, 1st Ave at 17th St, Baird Hall, 20th Floor, New York, NY 1000, USA.
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Friedrich RE, Zustin J. Paraffinoma of lips and oral mucosa: Case report and brief review of the literature. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2014; 3:Doc05. [PMID: 26504716 PMCID: PMC4582499 DOI: 10.3205/iprs000046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interstitial application of paraffin in plastic and reconstructive surgery is obsolete due to the development of permanent and extensive foreign body granulomas at the site of application. These granulomas can cause severe physical impairment and develop their own prognostic worth. Furthermore, the disperse oil droplets are not a locally stable suspension. Therefore, the desired aesthetic aspect can get lost in the course of a potential dislocation of the suspension. In addition, the interstitial confluence of non-resorbable droplets to larger oil drops causes palpable and sometimes visible indurations of the skin, the correlate of chronic inflammation. This case report describes the efforts undertaken to release the patient at least temporarily from her paraffin granulomas and to improve her appearance. The relevant literature is briefly discussed. Furthermore, we present some immunohistochemical findings to specify the foreign body reaction associated with paraffin injections into connective tissues.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
| | - Jozef Zustin
- Gerhard-Domagk-Institute of Pathology, Westfälische Wilhelms University, Münster, Germany
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Carella S, Romanzi A, Ciotti M, Onesti MG. Skin ulcer: a long-term complication after massive liquid silicone oil infiltration. Aesthetic Plast Surg 2013; 37:1220-4. [PMID: 24045933 DOI: 10.1007/s00266-013-0212-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/27/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite scientific literature replete with stories of disastrous results and disfigurement, illicit subcutaneous injections of highly viscous fluids in massive quantities still are performed, often by unqualified persons. The authors present a devastating long-term outcome from a massive volume of silicone oil injected subcutaneously into the buttocks of a 48-year-old transsexual patient and its ulceration treated only through regular medications. METHODS The therapeutic protocol consisted of wound disinfection with iodopovidone, washing with saline solution, disinfection with sodium hypochlorite 0.05 %, and application of ointment containing Vibrio alginolyticus collagenase and hyaluronan. The follow-up evaluation was at 1 and 2 weeks and then at 1, 2, and 3 months. Weekly photographs were taken, and measurements of the lesion and evolution were estimated every 7 days. RESULTS After 3 months of regular medications, the authors succeeded in closing the ulcer, avoiding invasive therapeutic options. CONCLUSION In the presence of the cutaneous ulceration above a massively infiltrated area, if the removal of all the injected oil is surgically definitely impossible, other conservative procedures should be considered. Our experience demonstrated how it is possible to manage a so prickly a case with a noninvasive approach such as periodic medications. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sara Carella
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy,
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Sejben I, Rácz A, Svébis M, Patyi M, Cserni G. Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia. Can Urol Assoc J 2012; 6:E137-9. [PMID: 23093564 DOI: 10.5489/cuaj.11146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- István Sejben
- Department of Surgical Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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Dermolipectomy of the thighs and buttocks to solve a massive silicone oil injection. Aesthetic Plast Surg 2009; 33:657-60. [PMID: 18704557 DOI: 10.1007/s00266-008-9229-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
Abstract
Despite scientific literature replete with stories of disastrous results and disfigurement, illicit subcutaneous injections of massive quantities of highly viscous fluids are still performed, often by unqualified persons. The authors present a devastating long-term outcome of subcutaneous injections of a massive volume of silicone oil in the buttocks of a 46-year-old female patient and its resolution through dermolipectomy of the thighs and buttocks.
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Abstract
We report a case of multisystem organ failure after large volume subcutaneous injection of castor oil for cosmetic enhancement. An unlicensed practitioner injected 500 mL of castor oil bilaterally to the hips and buttocks of a 28-year-old male to female transsexual. Immediate local pain and erythema were followed by abdominal and chest pain, emesis, headache, hematuria, jaundice, and tinnitus. She presented to an emergency department 12 hours postinjection. Persistently hemolyzed blood samples complicated preliminary laboratory analysis. She rapidly deteriorated despite treatment and developed fever, tachycardia, hemolysis, thrombocytopenia, hepatitis, respiratory distress, and anuric renal failure. An infectious diseases evaluation was negative. After intensive supportive care, including mechanical ventilation and hemodialysis, she was discharged 11 days later, requiring dialysis for an additional 1.5 months. Castor oil absorption was inferred from recovery of the Ricinus communis biomarker, ricinine, in the patient's urine (41 ng/mL). Clinicians should anticipate multiple complications after unapproved methods of cosmetic enhancement.
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Abstract
The use of injectable liquids for cosmetic purposes has been described by numerous clinicians informing the public of its destructive consequences. Several reports of layperson injections have come out recently indicating that the practice is still prevalent worldwide. Reports of self-administration of various liquid agents appear to have a unifying clinical presentation termed sclerosing lipogranulomatosis (SL). Although the clinical manifestations of SL were published at the turn of the century, the pathologic findings were not described until 1950. Immediate and delayed complications of this entity relate to the offending agent used and the site of injection. Some of the more commonly used liquids, paraffin (mineral oil), and polydimethyl siloxane (injectable silicone), have been administered to the scrotum, lower extremities, breast, and face. We report a case in which a patient injected mineral oil into his hips and describe the pathologic findings, complications, and subsequent course of treatment. We have also summarized the world's literature relating to the surreptitious injection of exogenous agents.
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Kathuria S, Westesson PL. Diffuse lipogranulomatosis involving soft tissues of the head and neck due to multiple self-injections of mineral oil. AJNR Am J Neuroradiol 2008; 29:1908-9. [PMID: 18617587 DOI: 10.3174/ajnr.a1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe imaging findings of a 45-year-old man with a 6-month history of gradually increasing diffuse swelling of the neck. CT showed diffuse thickening and infiltration of the superficial and deep soft tissues bilaterally. On further investigation of his history, the patient stated that he had injected mineral oil into his neck to clean out his body from drugs. Biopsy results showed multinucleated giant cells and inflammatory infiltrates confirming the diagnosis of lipogranulomatosis.
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Affiliation(s)
- S Kathuria
- Department of Imaging Sciences, the Division of Diagnostic and Interventional Neuroradiology, University of Rochester Medical Center, Rochester, NY, USA.
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Dadzie OE, Mahalingam M, Parada M, El Helou T, Philips T, Bhawan J. Adverse cutaneous reactions to soft tissue fillers – a review of the histological features. J Cutan Pathol 2008; 35:536-48. [DOI: 10.1111/j.1600-0560.2007.00853.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Acute Inflammatory Response of the Male Breasts Secondary to Self-injection of Petroleum Jelly: A Case Report. South Med J 2008; 101:422-4. [DOI: 10.1097/smj.0b013e3181684ae4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To report a case of extensive calcinosis cutis presumably caused by silicone injections, which was complicated by hypercalcemia. METHODS A long-standing case of calcinosis cutis with subsequent development of hypercalcemia is presented, and possible mechanisms for the underlying metabolic dysfunction are discussed. RESULTS A 78-year-old woman presented with severe hypercalcemia and was found to have extensive subcutaneous calcifications on the anterior chest wall and abdomen, likely related to previous silicone injections. The hypercalcemia was treated with intravenously administered pamidronate and aggressive rehydration. Resection of the extensive long-standing calcific deposits was not a viable option. The hypercalcemia resolved with treatment, but the patient died of urinary tract sepsis. CONCLUSION Extensive calcinosis cutis can result in hypercalcemia, possibly attributable to granulomatous reaction and vitamin D excess.
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Kuroda Y, Nacionales DC, Akaogi J, Reeves WH, Satoh M. Autoimmunity induced by adjuvant hydrocarbon oil components of vaccine. Biomed Pharmacother 2004; 58:325-37. [PMID: 15194169 DOI: 10.1016/j.biopha.2004.04.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Indexed: 01/27/2023] Open
Abstract
Adjuvant oils such as Bayol F (Incomplete Freund's adjuvant: IFA) and squalene (MF59) have been used in human and veterinary vaccines despite poor understanding of their mechanisms of action. Several reports suggest an association of vaccination and various autoimmune diseases, however, few were confirmed epidemiologically and the risk of vaccination for autoimmune diseases has been considered minimal. Microbial components, not the adjuvant components, are considered to be of primary importance for adverse effects of vaccines. We have reported that a single intraperitoneal injection of the adjuvant oils pristane, IFA or squalene induces lupus-related autoantibodies to nRNP/Sm and -Su in non-autoimmune BALB/c mice. Induction of these autoantibodies appeared to be associated with the hydrocarbon's ability to induce IL-12, IL-6, and TNF-alpha, suggesting a relationship with hydrocarbon's adjuvanticity. Whether this is relevant in human vaccination is a difficult issue due to the complex effects of vaccines and the fact that immunotoxicological effects vary depending on species, route, dose, and duration of administration. Nevertheless, the potential of adjuvant hydrocarbon oils to induce autoimmunity has implications in the use of oil adjuvants in human and veterinary vaccines as well as basic research.
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Affiliation(s)
- Yoshiki Kuroda
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Florida, ARB-R2-156, 1600 SW Archer Road, P.O. Box 100221 Gainesville, FL 32610-0221, USA
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Yel L, Chen W, Gupta S. Cellular immunodeficiency and autoimmunity in long-term mineral oil administration. Ann Allergy Asthma Immunol 2004; 92:88-91. [PMID: 14756470 DOI: 10.1016/s1081-1206(10)61716-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Leman Yel
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, California 92697, USA.
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Abstract
We report a 30-year-old-patient with penile sclerosing lipogranuloma following injections of Vaseline. He was successfully treated by complete surgical removal of the subcutaneous material and excision of atrophic skin, followed by penoplasty. Temporary impairment of wound healing was overcome by application of topical carbon dioxide gas. A brief review on international literature is given.
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Affiliation(s)
- K Hohaus
- Department of Dermatology and Institute of Pathology Georg Schmorl, Dresden, Germany
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Hage JJ, Kanhai RC, Oen AL, van Diest PJ, Karim RB. The devastating outcome of massive subcutaneous injection of highly viscous fluids in male-to-female transsexuals. Plast Reconstr Surg 2001; 107:734-41. [PMID: 11304599 DOI: 10.1097/00006534-200103000-00013] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Illicit subcutaneous injections of massive quantities of highly viscous fluids are still performed, often by unqualified persons. Fifteen male-to-female transsexuals consulted the authors regarding their devastating long-term outcomes after the injection of up to 8 liters of alleged silicone or mineral oil to feminize their bodies. After a latency period of up to 17 years, these injections led to complications ranging from scarring and deformity to infections. These patients were treated conservatively for inflammation and infection or surgically by resection of the oil-infested areas. In view of the potential dangers, feminization by the injection of high-viscosity fluids should be soundly condemned.
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Affiliation(s)
- J J Hage
- Departments of Plastic and Reconstructive Surgery at the Antoni van Leeuwenhoek Hospital, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
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Lombardi EL, van Servellen G. Building culturally sensitive substance use prevention and treatment programs for transgendered populations. J Subst Abuse Treat 2000; 19:291-6. [PMID: 11027900 DOI: 10.1016/s0740-5472(00)00114-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies show that transgendered individuals are at high risk for substance use problems. It is important to identify the unique needs and concerns of these individuals and culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse treatment services. This involves incorporating the needs of services from the perspectives of both the transgendered community and health-care professionals. It is the purpose of this article to discuss transgenderism as well as the substance use problems and difficulties within substance use treatment that transgendered men and women may face. This article presents guidelines for the design and evaluation of health-care services to transgendered populations.
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Affiliation(s)
- E L Lombardi
- UCLA, Drug Abuse Research Center, 1640 South Sepulveda Boulevard, Suite 200, Los Angeles, CA 90025, USA.
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Lombardi EL, van Servellen G. Correcting deficiencies in HIV/AIDS care for transgendered individuals. J Assoc Nurses AIDS Care 2000; 11:61-9. [PMID: 11022332 DOI: 10.1016/s1055-3290(06)60385-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies suggest that transgendered individuals are at high risk for acquiring HIV through injection drug use and sexual risk behaviors. Beginning efforts are being directed to identify the unique needs and concerns of these individuals and to develop culturally sensitive programs that will be successful in recruiting and retaining these individuals in drug abuse and HIV treatment services. These efforts include examining the available and needed services from the perspectives of both the transgendered community and health care professionals. This article reviews the phenomenon of transgenderism and the social context that places these individuals at risk for HIV. Additionally, this article proposes some guidelines for those who are in positions responsible for designing, evaluating, and implementing existing health care services to transgendered populations.
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Affiliation(s)
- E L Lombardi
- Drug Abuse Research Center, University of California, Los Angeles, USA
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Darsow U, Bruckbauer H, Worret WI, Hofmann H, Ring J. Subcutaneous oleomas induced by self-injection of sesame seed oil for muscle augmentation. J Am Acad Dermatol 2000; 42:292-4. [PMID: 10642691 DOI: 10.1016/s0190-9622(00)90144-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case presentation describes a 48-year-old man who experienced subcutaneous nodules 9 months after self-injection of sesame seed oil into the pectoral area for muscle augmentation. This procedure was reported by our patient to be frequently performed in the body-building and fitness scene. Ultrasound imaging showed multiple, low reflecting round nodular areas of up to 1 cm diameter in both breasts. Excision of a representative nodule revealed a cyst filled with oily material, surrounded by granulomatous tissue. This case report demonstrates an unusual side effect of augmentation measures in body-builders.
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Affiliation(s)
- U Darsow
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 23-1998. Tachypnea, changed mental status, and pancytopenia in an elderly man with treated lymphoma. N Engl J Med 1998; 339:254-61. [PMID: 9687245 DOI: 10.1056/nejm199807233390408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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