An unusual late reaction to Zyderm I injections: a challenge for treatment

We describe a patient who, 2 1/2 years after injection with Zyderm I collagen, developed large erythematous indurated nodules and plaques at the facial injection sites. This occurred despite a prior negative skin test with the injectable material. Histopathologically, a sarcoid-like foreign-body reaction was present in the dermis and subcutaneous fat and muscles. Retesting with Zyderm I collagen on the forearm produced a positive reaction that showed, histologically, a sarcoid-like reaction similar to that which was found in the face. Various modes of therapy have failed to clear the facial lesions and disfigurement.