Clinical Challenge: Progressive Discoloration of the Buttocks - MPR

Clinical Challenge: Progressive Discoloration of the Buttocks

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A 53-year-old woman presents with a 3-year history of progressive discoloration of her buttocks. Medical history is negative for systemic disease, and the patient states that a recent chest radiograph was negative. She reports having undergone a cosmetic enhancement procedure to the site several years earlier in the Dominican Republic. The condition is asymptomatic but of cosmetic concern. Examination reveals dusky red, slightly indurated, well-demarcated plaques on both buttocks.

Injectable exogenous modeling agents have been used for decades to enhance cosmesis. A commonly used substance is liquid silicone.In the United States, medical-grade silicone is standardized, sterile, and administered in microdroplets.1,2 Non-medical-grade silicone, however, is readily available, inexpensive, and frequently administered...

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Injectable exogenous modeling agents have been used for decades to enhance cosmesis. A commonly used substance is liquid silicone.

In the United States, medical-grade silicone is standardized, sterile, and administered in microdroplets.1,2 Non-medical-grade silicone, however, is readily available, inexpensive, and frequently administered in significant volume within clinics throughout Central and South America, resulting in significant morbidity, including silicone granuloma.3

Acute complications from silicone injections into the buttocks include edema and cellulitis. Granulomatous reactions may arise months or years after the procedure and are typically associated with administration by unlicensed practitioners.Isolated granulomas can be removed surgically, but extensive involvement is difficult to manage. Improvement has been reported with oral minocycline, steroid drugs, and etanercept.4-6

Lawrence Schiffman, DO, is the director of Miami Skin Dr. in Doral, Florida. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. 1. Sobanko J, Scheinfeld N, Kriegel D. Liquid injectable silicone: Should you implement it in your practice? Cosmetic Dermatology. 2006;19:534-536.
  2. 2. Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. 2006;118(3 Suppl):77S-84S.
  3. 3. Duffy DM. The silicone conundrum: a battle of anecdotes. Dermatol Surg. 2002;28:590-594.
  4. 4. Singh M, Solomon IH, Calderwood MS, Talbot SG. Silicone-induced granuloma after buttock augmentation. Plast Reconstr Surg Glob Open. 2016;4:e624.
  5. 5. Arin MJ, Bäte J, Krieg T, Hunzelman N. Silicone granuloma of the face treated with minocycline. J Am J Acad Dermatol. 2005;52(2 Suppl 1):53-56.
  6. 6. Desai AM, Browning J, Rosen T. Etanercept therapy for silicone granuloma. J Drugs Dermatol. 2006;5:894-896.