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Cosmetic permanent fillers for soft tissue augmentation: a new contraindication for interferon therapies
Joerg Fischer1, Gisela Metzler, Martin Schaller
1Department of Dermatology, Eberhard-Karls-University Tübingen, Tübingen, Germany.
Background:
Most of the new fillers used for soft tissue augmentation in aesthetic dermatology are considered well tolerated, but very little data are available on their long-term tolerability, especially in patients receiving immunomodulatory therapy.
Observations:
A 48-year-old woman presented with disfiguring facial edema 10 weeks after she began antiviral therapy with peginterferon alfa-2a and ribavirin for chronic hepatitis C infection. The major affected sites had been treated 10 years before with Artecoll, a permanent filler containing polymethylmethacrylate. A treatment attempt with allopurinol was initiated while antiviral therapy was continued and was successfully completed after 6 months. Despite significant improvement, extended plastic surgery was necessary for facial reconstruction.
Conclusions:
The normal host response to a cosmetic filler is a weak granulomatous reaction. Interferon and other immunostimulatory medications can lead to an exacerbation of this preexisting low-grade chronic inflammation that is quite similar to interferon-triggered sarcoidosis. This potential long-term risk has medicolegal implications for informed consent and for the potential use of both permanent fillers and interferon.
