%0 Journal Article
%T The Therapeutic Benefit of Allopurinol in the Treatment of Foreign Body Granulomas Caused by Polymethylmethacrylate Microspheres
%A Luisa Kelmer C£¿rtes de Barros Silveira
%A Felipe Ladeira de Oliveira
%A Thais de Barros Castro Alves
%A Maria Lourdes Candela Rambaldi
%A Felipe Cupertino de Andrade
%A Santuzza de Carvalho Kelmer
%A Fabio Cuiabano Barbosa
%J Case Reports in Dermatological Medicine
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/945205
%X Injectable polymethylmethacrylate (PMMA) microspheres are nonbiodegradable and too large for macrophage phagocytosis. There are several complications possible to happen, like chronic nonspecific inflammatory reactions, lip stiffness, infection, and granulomas. The occurrence of granulomas can lead to a not aesthetic result, making some extreme changes in the patient¡¯s life. The objective of this case report is to describe the successful treatment of foreign body granulomas caused by polymethylmethacrylate microspheres using allopurinol, an innovative therapy for this condition. 1. Introduction Injectable polymethylmethacrylate (PMMA) is composed of 80% bovine collagen and a suspension of 20% nonreabsorbable PMMA. In Brazil, one of the types used is Metacrill (Nutricel Laborat¨®rios, Rio de Janeiro, Brazil), made of polymethylmethacrylate microspheres (30%) ranging from 40 to 60£¿mm in diameter, which is suspended in a nonabsorbable chemical colloid composed of carboxymethylcellulose [1]. The action mechanism consists on the collagen carrier being degraded by the body within 1¨C3 months, so the collagen recently formed is deposited. It is encapsulated and engulfed by the remaining PMMA particles, which are extremely long lasting and may be permanent [2]. The PMMA microspheres are nonbiodegradable and too large for macrophage phagocytosis. There are several complications possible to happen, like chronic nonspecific inflammatory reactions, lip stiffness, infection, nodules, tissue necrosis, lymphedema, and granulomas. The formation of a massive giant cell around an implant indicates foreign body granuloma. Granuloma is a multinucleated giant cell surrounded by palisading macrophages enveloped in a halo of lymphocytes [3]. The occurrence of granulomas can lead to a not aesthetic result, making some extreme changes in the patient¡¯s life. 2. Case Representation A patient, 56-year-old, female, born in and resident of the city of Rio de Janeiro, went to the ambulatory of a dermatology clinic complaining of facial swelling for one month. She states that in August 2000 she consulted a plastic surgeon for cosmetic purposes and underwent a filling procedure of the nasolabial folds, glabellar region, and lips with PMMA. In July 2011, 11 years after the procedure, the patient presented edema and nodules with a petrified consistency in the areas where the substance had been injected (Figures 1 and 2). In addition, she presented infiltration of a prior scar on the left knee, making it hypertrophic (Figure 3). The patient was psychologically affected not allowing a skin
%U http://www.hindawi.com/journals/cridm/2012/945205/