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Facial sclerosing lipogranuloma following misuse: case report A 44-year-old man developed facial sclerosing lipogranuloma following misuse of fish oil and hyaluronic acid in the form of home made filler. The man, who had a history of anxiety, presented with one day history of progressive facial erythema and oedema following 3 days of injecting a homemade filler into the malar cheeks, melolabial folds and infraorbital skin. He had a 2 year history of administrating a heated mixture of fish oil and hyaluronic acid [quantity of administration not stated] from over the counter dietary supplement capsules. He did not have a pruritus or pain; however, he reported that his skin felt "tight" and "swollen". He was hospitalised for further interventions. At presentation and throughout his inpatient hospital course, he was afebrile. Dermatological examination showed an erythematous, oedematous red plaque involving the bilateral malar cheeks, nose, glabella and periorbital skin. Also, an overlying peau d’orange-like change was noted. He had periorbital oedema, impaired eye opening, which reduced his field of vision. A CT scan of head and neck did not reveal an evidence of underlying retro-orbital cellulitis, sinus involvement or lymhadenopathy. Punch biopsy showed a superficial and deep, perivascular, periadnexal and interstitial lymphohistiocytic infiltrate with a rare neutrophils. Higher power examination showed xanthomatized, amphophilic, globular and wispy interstitial deposits surrounded by foamy histiocytes, neutrophils and scant leukocytoclasis. Micro-organisms were absent. Tissue culture was negative for fungus and mycobacteria; however, it showed growth of rare coagulase negative Staphylococcus bacteria. The man was treated with prednisone taper for 3 weeks along with desonide ointment and oral cephalexin. Within 72h, a dramatic reduction in swelling and erythema was noted along with normalisation of visual fields. Eventually, he was discharged on a 7 days course of cephalexin with no further complications. At one month follow-up, his facial cutaneous examination returned to the baseline. Thomas J, et al. Facial Sclerosing Lipogranuloma After Self-Injection of Homemade Tissue Filler: An Alarming New Practice. Dermatologic Surgery 46: 711-713, No. 5, May 803519237 2020. Available from: URL: http://doi.org/10.1097/DSS.0000000000001904

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Reactions 5 Dec 2020 No. 1833