The injection of silicone or paraffin generates an immunological reaction which consists of granulomas in both the dermis and subcutaneous cellular tissue, characterized by the presence of intracellular and extracellular material, similar to those seen in sarcoidosis. It is not yet determined how the injury occurs, but it may appear immediately or any time up to 20 or more years after the substance has been injected.
The most effective treatment of these granulomas is the surgical removal of damaged material and tissue. However, in some cases, surgery is deemed either infeasible or too risky. Such occurs when (1) the injury is so extensive and/or the location so crucial that surgery would be grossly mutilating or (2) when it is impossible to perform satisfactory surgical removal due to the involvement of essential anatomical structures like major blood vessels, nerves, or even a nerve plexus (e.g., lower limbs, shoulders, axilla with compromise of the brachial plexus, face, etc.). For such patients, pharmacological treatments have been proposed. There is currently no international consensus about which of these is the best medical treatment or about how long treatment should be continued. The clinical presentation, severity, and progression of disease must always be taken into account when trying to select the best treatment.
We propose the following therapeutic pharmacological-immunomodulatory algorithms, based upon our experience and the literature.
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