A Case of Foreign-Body Granuloma of the Glabella due to Polyacrylamide Filler and an Intractable Ulcer after Skin Biopsy: An Immunohistochemical Evaluation of Inflammatory Changes
A 57-year-old woman was referred to our hospital with a 3-month history of swelling of her glabella. The patient stated that the swelling had become rigid and indurated. Examination revealed a tumor of the glabella (fig. ). The tumor was 2 cm in diameter and was not well demarcated; it was skin colored and caused no redness, pain, or heat. The patient's medical history was unremarkable, with no previous cosmetic interventions. An ultrasound examination of the tumor revealed hypoechoic deposits predominating in the subcutaneous tissue of the glabella and dorsum of the nose (fig. ). A skin biopsy was performed for diagnostic purposes. Examination of the specimen revealed granulomas consisting of histiocytes and foreign-body giant cells with patchy infiltration of lymphocytes and fibroblasts. Amorphous materials were embedded in the giant cells (fig. ). We asked the patient again if she had received a cosmetic filler injection. She finally admitted that she had had a polyacrylamide gel injection in the glabella 1 year before. We diagnosed her with foreign-body granulomas of the glabella due to polyacrylamide filler.\nAs there remained a slight induration along the surgical scar, the patient was started on oral tranilast (300 mg per day) and hydrocortisone butyrate 0.1% ointment for 4 months, which resulted in no improvement. The treatment was discontinued, and the tumor was observed without treatment. One year later, the tumor became swollen and red (fig. ). We performed an incisional biopsy for diagnosis and again found foreign-body granulomas with diffuse infiltration of lymphocytes and neutrophils (fig. ). After the biopsy, the surgical incision did not close despite suturing, and an ulcer formed on the patient's glabella, which became red and infected with purulent discharge. Although she was treated with cefdinir (300 mg per day) and sulfadiazine silver cream, the ulcer persisted for 5 months and still remained unhealed.