Case Report/Case Series |

Facial Allergic Granulomatous Reaction and Systemic Hypersensitivity Associated With Microneedle Therapy for Skin Rejuvenation

Razieh Soltani-Arabshahi, MD1; Jillian W. Wong, MS2; Keith L. Duffy, MD1; Douglas L. Powell, MD1
[+] Author Affiliations
1Department of Dermatology, School of Medicine, University of Utah, Salt Lake City
2Medical Student, School of Medicine, University of Utah, Salt Lake City
JAMA Dermatol. 2014;150(1):68-72. doi:10.1001/jamadermatol.2013.6955.
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Importance  Microneedle therapy includes skin puncture with multiple micro-sized needles to promote skin rejuvenation or increase transdermal delivery of topical medications. In cosmetic practices, various cosmeceuticals are applied before microneedling to enhance the therapeutic effects. This results in intradermal tattooing of the topical product. Despite rapid increase in the use of microneedles in dermatology, there are few data about their safety.

Observations  We describe 3 women, aged 40s to 60s, who developed facial granulomas following microneedle therapy for skin rejuvenation. Two patients had undergone microinjection of the same branded topical moisturizer (Vita C Serum; Sanítas Skincare) during microneedle therapy. Biopsy in all cases showed foreign body–type granulomas. Results of tissue cultures were negative. Chest radiography and serum angiotensin-converting enzyme findings were normal. The first 2 patients had a positive patch test reaction to Vita C Serum. Initial treatment with topical and oral corticosteroids was ineffective. Therapy with doxycycline hydrochloride and minocycline hydrochloride led to partial improvement in one case and resolution in another.

Conclusions and Relevance  Application of topical products prior to microneedling can introduce immunogenic particles into the dermis and potentiate local or systemic hypersensitivity reactions. Because the microneedle therapy system is accessible for home use, health care providers need to be aware of its potential consequences.

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Figure 1.
Facial Granulomatous Reaction After Microneedle Therapy in 3 Women

Indurated erythematous plaques affected the entire face, sparing the untreated periorbital area, immediate periorbital area, and nasal sidewalls in the patients described in case 1 (A) and case 2 (B) 3 months after microneedle therapy for skin rejuvenation. Similar indurated erythematous papules developed on the cheeks and chin in the patient presented in case 3 (C).

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Figure 2.
Skin Biopsy Specimen From Facial Granulomas After Microneedle Therapy

Skin biopsy showed a foreign body–type granulomatous reaction with dermal histiocytes and foreign body giant cells surrounded by lymphocytes and few plasma cells. Hematoxylin-eosin; original magnification ×40 (A) and ×200 (B).

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Figure 3.
Patch Test in a Patient With Granulomatous Reaction After Microneedle Therapy

Patch testing with a standard tray, cosmetic tray, and Vita C Serum showed a +1 positive reaction consisting of grouped erythematous edematous papules after 96 hours.

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