Case and Research Letters
Adverse Reactions to Fillers in Men: A Retrospective Study of Epidemiological and Clinical Characteristics and the Usefulness of Diagnostic Ultrasound
Complicaciones de rellenos (fillers) en hombres. Estudio retrospectivo de las características epidemiológicas y clínicas. Utilidad de la ecografía en el diagnóstico
D. Morgado-Carrasco
, X. Bosch-Amate, X. Fustà-Novell, P. Giavedoni
Corresponding author
Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Morgado-Carrasco, X. Bosch-Amate, X. Fustà-Novell, P. Giavedoni" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "morgadodaniel8@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Bosch-Amate" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Fustà-Novell" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones de rellenos (<span class="elsevierStyleItalic">fillers</span>) en hombres. Estudio retrospectivo de las características epidemiológicas y clínicas. Utilidad de la ecografía en el diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1651 "Ancho" => 759 "Tamanyo" => 136948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Significant increase in volume on the dorsal aspect of both feet of patient 1. B, Color Doppler ultrasound (18-MHz probe) in patient 1 reveals a small anechoic pseudocyst with posterior reinforcement, no increase in vascularization, and a snowstorm-like pattern.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of fillers for esthetic purposes has increased in recent years. Complications secondary to the use of permanent and nonpermanent fillers have been widely described.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> However, the literature on complications in men is scarce. Here, we describe the clinical and epidemiological characteristics of men with adverse reactions to fillers.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We carried out a retrospective study of men with adverse reactions to fillers who visited the dermatology department of the Hospital Clínic de Barcelona between May 1, 2015, and October 31, 2018. Corresponding medical records, photographs, and additional tests were reviewed. Ultrasound evaluation was performed using an Esaote Mylab ClassC kit with 18-MHz and 22-MHz probes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our analysis included 6 men (one of whom was the subject of a previous publication<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>): 1 was transsexual; 3 were men who have sex with men (MSM); and 2 were heterosexual (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Three of the patients had human immunodeficiency virus (HIV). All had been referred from another service with different diagnoses. Adverse reactions to fillers were never suspected. The most frequent filler injection site was the buttocks (4 patients), followed by the face (2 patients). The patients reported receiving injections of hyaluronic acid (1 patient), liquid silicone (2 patients), petrolatum (1 patient), polyalkylimide (1 patient), and an unknown agent (1 patient). Two of the 6 patients initially denied having undergone dermal filling. The time from infiltration to adverse reaction ranged from 2 to 15 years. The most frequent clinical presentations were recurrent pseudocellulitis (4 patients), filler migration (3 patients), nodule formation (2 patients), and knee pain (1 patient). Two of the patients had undergone computed axial tomography (CAT), which revealed signs of myositis and cellulitis (patients 2 and 5), but not the presence of filling agent. High frequency ultrasound (HIFU) revealed findings compatible with adverse reaction to filler in all cases. In 1 patient who was unaware of the type of filler used, HIFU revealed a snowstorm-like pattern characteristic of liquid silicone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In another individual who reported having received hyaluronic acid infiltrations, HIFU revealed characteristics compatible with petrolatum (anechoic pseudocysts) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In 1 case, treatment consisted of removal of the filler. Three patients were treated with oral corticosteroids, 2 with minocycline, and 2 with nonsteroidal anti-inflammatory drugs. One patient was lost to follow-up. The clinical response was variable (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Adverse reactions to fillers can cause severe morbidity with foreign body granulomatous reactions, pseudocellulitis, skin necrosis, embolization and migration of filler material, and even death.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,3</span></a> In our series, the most common complications were pseudocellulitis and filler migration.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It should be noted that all patients were referred from other services and in no case was adverse reaction to filler suspected, likely due to the great variability in clinical presentation, the long latency to symptom onset (up to 15 years in our series), a reluctance to admit having undergone the procedure (or failure to recall the procedure in cases in which many years had elapsed), and a lack of suspicion of this condition in men. The misdiagnosis of recurrent cellulitis or myositis led in several cases to costly imaging tests and multiple cycles of broad-spectrum antibiotic therapy, with potential associated adverse effects.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some authors have suggested that the use of unauthorized fillers such as liquid silicone and petrolatum is increasing among transsexuals and bodybuilders.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a> In our series, most of the fillers used corresponded to this group (silicone and petrolatum in 3 and 2 cases, respectively). However, only 1 of the individuals was transsexual, none were bodybuilders, and 2 were heterosexual, underscoring the need for a high index of clinical suspicion when evaluating men with inflammatory dermatoses, especially on the face, buttocks, and thighs.</p><p id="par0035" class="elsevierStylePara elsevierViewall">HIFU is a fast, inexpensive, and safe test. It is useful in the diagnosis of adverse reaction to filler to assess the magnitude of the inflammatory reaction, identify the type of filling agent used, monitor the response to treatment, and guide procedures.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5–7</span></a> In our series, HIFU revealed the presence of fillers in all cases, even in 2 patients in whom CAT failed to do so.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The only curative treatment for adverse reaction to filler is extraction of the filling agent,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> which can be difficult; this was achieved in only 1 patient in our series. Variable responses have been described in patients treated with oral and intralesional corticosteroid therapy, tacrolimus, allopurinol, etanercept, and antibiotics such as clarithromycin and tetracyclines.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,3</span></a> Most patients in our series received oral corticosteroids, and 1 patient (patient 2) required low doses of prednisone for more than 12 months.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Adverse reaction to filler in men can occur more than a decade after the procedure, can have varied clinical presentations, and is not limited to MSM or transsexuals. It should be suspected in individuals with inflammatory conditions affecting the face, thighs, or buttocks, even in those who deny having undergone dermal filling.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Morgado-Carrasco D, Bosch-Amate X, Fustà-Novell X, Giavedoni P. Complicaciones de rellenos (<span class="elsevierStyleItalic">fillers</span>) en hombres. Estudio retrospectivo de las características epidemiológicas y clínicas. Utilidad de la ecografía en el diagnóstico. Actas Dermosifiliogr. 2020;111:429–432.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1651 "Ancho" => 759 "Tamanyo" => 136948 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Significant increase in volume on the dorsal aspect of both feet of patient 1. B, Color Doppler ultrasound (18-MHz probe) in patient 1 reveals a small anechoic pseudocyst with posterior reinforcement, no increase in vascularization, and a snowstorm-like pattern.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1573 "Ancho" => 755 "Tamanyo" => 174979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous edematous plaque on the left thigh of patient 5. B, Numerous hypoechoic or anechoic pseudocysts in subcutaneous tissue in patient 5 (B-mode ultrasound with 18-MHz probe). C, Increased vascularization in patient 5 (color Doppler ultrasound with 18-MHz probe).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: HIV, human immunodeficiency virus; F, female; IgM, immunoglobulin M; M, man; M2F, male-to-female transition; MSM, men who have sex with men; N/A, not applicable; NSAIDs, nonsteroidal anti-inflammatory drugs; ST, subcutaneous tissue.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender Identity/Sexual Orientation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidities \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of Filler/Infiltration Site \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adverse Effect (Time Since Infiltration) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dermal Filling Denied by Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">High Frequency Ultrasound \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Referral Diagnosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Response to Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F (M2F)/unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liquid silicone/buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Migration to feet and secondary lymphedema (3<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Snowstorm pattern. Small anechoic pseudocysts. No increase in vascularity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lymphedema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N/A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/heterosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Petrolatum/buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Repeated pseudocellulitis in buttocks and sacrum (2<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudocysts in ST and muscle. Increased vascularity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrent cellulitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HydroxychloroquineAllopurinolMinocyclineOral prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only responded to prolonged oral prednisone therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/heterosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HypertensionIgM monoclonal gammopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liquid silicone, unknown/face<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous nodules, edema, and limited buccal mobility (12<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Snowstorm pattern. Increased vascularity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Autoinflammatory syndrome (Schnitzler syndrome) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MinocyclineOral prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good response to prednisone, then discontinued treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polyalkylimide/face \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous nodules on both cheeks (5<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudocyst beneath the muscle. Increased vascularity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rosacea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Filler removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good response \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0010">**</a>Hyaluronic acid, petrolatum/buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudocellulitis on the right thigh, myositis (12<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudocysts in ST and muscle. Increased vascularity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myositis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral prednisoneNSAIDs (dexketoprofen) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good response \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M/MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liquid silicone/buttocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knee pain, nodules on thighs, pseudocellulitis (15<span class="elsevierStyleHsp" style=""></span>y) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Snowstorm pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fasciitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin-clavulanic acidNSAIDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Partial response, nodules and discomfort persisted \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2443829.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Patient was unaware of the composition of the filler. Snowstorm ultrasound pattern was compatible with liquid silicone.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Patient reported receiving hyaluronic acid infiltration. The time to onset of adverse effects and the ultrasound characteristics of the filler were compatible with petrolatum.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidemiological and Clinical Characteristics, Additional Tests, and Treatments of Men with Adverse Reactions to Fillers</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Materiales de relleno: tipos, indicaciones y complicaciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Sánchez-Carpintero" 1 => "D. Candelas" 2 => "R. 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Oliveira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bras Cir Plást" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "136" "paginaFinal" => "139" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sonographic outcomes of cosmetic procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "X. Wortsman" 1 => "J. Wortsman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2011" "volumen" => "197" "paginaInicial" => "W910" "paginaFinal" => "W918" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ecografía de los materiales de relleno inyectables y su interés en el seguimiento diagnóstico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.M. De Cabo-Francés" 1 => "J.M. Alcolea" 2 => "I. Bové-Farré" 3 => "C. 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Rivera-Díaz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermo-Sifiliogr" "fecha" => "2017" "volumen" => "108" "paginaInicial" => "478" "paginaFinal" => "480" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000005/v3_202012020957/S1578219020301414/v3_202012020957/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000005/v3_202012020957/S1578219020301414/v3_202012020957/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020301414?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 9 | 15 |
| 2024 October | 72 | 56 | 128 |
| 2024 September | 78 | 29 | 107 |
| 2024 August | 96 | 64 | 160 |
| 2024 July | 69 | 37 | 106 |
| 2024 June | 80 | 30 | 110 |
| 2024 May | 68 | 42 | 110 |
| 2024 April | 76 | 24 | 100 |
| 2024 March | 68 | 31 | 99 |
| 2024 February | 70 | 31 | 101 |
| 2024 January | 70 | 35 | 105 |
| 2023 December | 63 | 15 | 78 |
| 2023 November | 74 | 34 | 108 |
| 2023 October | 58 | 26 | 84 |
| 2023 September | 64 | 28 | 92 |
| 2023 August | 39 | 13 | 52 |
| 2023 July | 50 | 36 | 86 |
| 2023 June | 40 | 23 | 63 |
| 2023 May | 55 | 20 | 75 |
| 2023 April | 42 | 26 | 68 |
| 2023 March | 77 | 38 | 115 |
| 2023 February | 52 | 26 | 78 |
| 2023 January | 34 | 25 | 59 |
| 2022 December | 51 | 35 | 86 |
| 2022 November | 45 | 30 | 75 |
| 2022 October | 33 | 28 | 61 |
| 2022 September | 29 | 25 | 54 |
| 2022 August | 25 | 44 | 69 |
| 2022 July | 22 | 35 | 57 |
| 2022 June | 41 | 40 | 81 |
| 2022 May | 37 | 48 | 85 |
| 2022 April | 39 | 41 | 80 |
| 2022 March | 37 | 58 | 95 |
| 2022 February | 46 | 29 | 75 |
| 2022 January | 55 | 33 | 88 |
| 2021 December | 51 | 39 | 90 |
| 2021 November | 36 | 44 | 80 |
| 2021 October | 56 | 52 | 108 |
| 2021 September | 37 | 35 | 72 |
| 2021 August | 33 | 30 | 63 |
| 2021 July | 31 | 34 | 65 |
| 2021 June | 25 | 36 | 61 |
| 2021 May | 29 | 48 | 77 |
| 2021 April | 87 | 88 | 175 |
| 2021 March | 33 | 36 | 69 |
| 2021 February | 37 | 35 | 72 |
| 2021 January | 36 | 19 | 55 |
| 2020 December | 28 | 17 | 45 |
| 2020 November | 16 | 14 | 30 |
| 2020 October | 20 | 17 | 37 |
| 2020 September | 33 | 18 | 51 |
| 2020 August | 83 | 28 | 111 |
| 2020 July | 71 | 26 | 97 |
| 2020 June | 32 | 26 | 58 |
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