Facial self-induced paraffinoma in an elderly woman

A 72-year-old Caucasian woman without remarkable medical history presented with an asymptomatic bilateral periocular swelling, which had been present for 2 months. Physical examination showed symmetric indurated periocular erythematous plaques (Figure 1). Biopsy of a skin lesion revealed aggregates of vacuoles of different sizes (Figure 2) surrounded by a prominent inflammatory infiltrate constituted by macrophages, lymphocytes, neutrophils, and granulomatous foreign body reaction throughout the reticular dermis and hypodermis. These histological findings were consistent with the injection of an oily foreign substance. The patient denied the self-induced nature of the lesions, so she was referred for psychiatric evaluation and admitted having self-injected mineral oil as an impulsive attempt to get attention from her family. She was diagnosed with borderline personality disorder (BPD) and started treatment with oral fluoxetine, showing a rapid decrease of impulsive behavior and anxiety from the second week with a mean dose of 80 mg/d.