Background and Importance The administration of silicone as a filler material is associated with the development of inflammatory granuloma due to an increase in the proinflammatory cytokine tumour necrosis factor (TNF-α). Based on the pathophysiology of granulomas, anti-TNF- α drugs are postulated as possible therapeutic alternative for patients not responding to initial treatments.
Aim and Objectives To describe the efficacy and safety of the use of adalimumab in patients diagnosed with inflammatory facial granuloma due to filler material (silicone).
Material and Methods A 3-month retrospective descriptive observational study of a patient under treatment with adalimumab for inflammatory facial granuloma due to silicone.
Study variables included number and size of granulomas and adverse events (AE) occurrences associated with adalimumab.
Results 62-year-old woman follow-up by dermatology department due to inflammation compatible with silicone showed three lesions, one on the glabella and two on the cheeks. She received as first line treatment systemic corticosteroids (partial control of the process), methotrexate (no clinical response and even worsening after 3 weeks), doxycycline (no clinical response after 6 weeks) and finally hydroxychloroquine in association with doxycycline (no clinical response). She starts adalimumab 40 mg/2weeks.
- Response: After 6 doses of adalimumab were administered (12 weeks of treatment) combined with doxycycline 100mg/24h and hydroxychloroquine 400 mg/24h. Since treatment started patient experienced a decrease in the number of lesions and a reduction in the size of the masses: from three initial lesions only lesion at the glabella level remains visible and palpable. After objective clinical improvement it was decided to withdraw doxycycline and infiltration of dexamethasone at the persistent lesion. Treatment with adalimumab together with hydroxychloroquine was maintained.
The patient did not report any AE associated with the use of adalimumab.
Conclusion and Relevance The use of adalimumab in this patient showed objective clinical benefits over previously used alternative treatments by achieving a significant reduction in the number and size of lesions in a reduced treatment time without experiencing AE. Together with the evidence collected previously the use of TNF-α inhibitors
Conflict of Interest No conflict of interest