Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options

Am J Clin Dermatol. 2013 Oct;14(5):401-11. doi: 10.1007/s40257-013-0043-7.

Abstract

Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.

Publication types

  • Review

MeSH terms

  • Acrylic Resins / adverse effects
  • Adipose Tissue / transplantation
  • Biocompatible Materials / adverse effects*
  • Collagen / adverse effects
  • Dermatologic Agents / adverse effects*
  • Durapatite / adverse effects
  • Granuloma, Foreign-Body / chemically induced*
  • Granuloma, Foreign-Body / etiology
  • Granuloma, Foreign-Body / pathology*
  • Granuloma, Foreign-Body / therapy
  • Humans
  • Hyaluronic Acid / adverse effects
  • Hydrogels / adverse effects
  • Lactic Acid / adverse effects
  • Methylmethacrylates / adverse effects
  • Polyesters
  • Polyhydroxyethyl Methacrylate / adverse effects
  • Polyhydroxyethyl Methacrylate / analogs & derivatives
  • Polymers / adverse effects
  • Polymethyl Methacrylate / adverse effects
  • Silicones / adverse effects
  • Transplantation / adverse effects

Substances

  • Acrylic Resins
  • Biocompatible Materials
  • Dermatologic Agents
  • Hydrogels
  • Methylmethacrylates
  • Polyesters
  • Polymers
  • Silicones
  • polyhydroxyethyl methacrylate hydrogels
  • Polyhydroxyethyl Methacrylate
  • Lactic Acid
  • poly(lactide)
  • polyacrylamide
  • poly(ethylmethacrylate)
  • Hyaluronic Acid
  • Collagen
  • Polymethyl Methacrylate
  • Durapatite