Case Report from JAMA Dermatology — Twelve-Year Analysis of Severe Cases of Drug Reaction With Eosinophilia and Systemic Symptoms — A Cause of Unpredictable Multiorgan Failure

Background: Cosmetic filler injections are now a very common procedure for aesthetic purposes. Today no contra-indication is given anymore to any patient for an intradermal filling. Objectives: We draw attention to a possible side effect of facial fillers in a population at risk. Results: We report 2 similar cases of systemic sarcoidosis in patients who both developed a sarcoidal granuloma at the location of a cosmetic filler injection during combined interferon and ribavirin treatment for chronic hepatitis C infection. Cosmetic fillers were hyaluronic acid for one patient and probably silicone for the other. Conclusion: Patients with chronic hepatitis C have a higher risk of interferon-induced sarcoidosis. Physicians must be aware of the risk that a granuloma can develop after a dermal filler injection especially in patients treated with interferon for chronic hepatitis C. These reactions may reveal a systemic sarcoidosis. We propose to perform a test for a hepatitis C virus infection before injecting a dermal filler and to inform the patient of this risk in case of a hepatitis C infection that could necessitate an interferon treatment.

Melanoma is increasing in most white populations, with the incidence doubling every 10 years.¹ Several phenotypic risk factors have been identified, including the number of melanocytic nevi, the presence of dysplastic nevi, a freckling tendency, the propensity for sunburn, and the number of severe sunburn episodes during childhood.² The strongest risk factor for the development of cutaneous melanoma in white populations is the number of acquired melanocytic nevi.^3-6 Most studies found that melanocytic nevi are more common in children with light blue eyes, light skin, and fair hair.⁷ Sunlight exposure, as measured by sunburn history and exposure, particularly during vacations and on weekends, is one of the major factors in the development of nevi. The pattern and timing of solar exposure are probably important, and many authors have proved that early exposure, before age 15 years, is associated with later development of melanoma.⁸ Irradiation with visible spectral regions could have a role in human beings similar to that in the animal model of tropical fish of the genus Xiphophorus, in which irradiation with light energy (wavelength >320 nm, including UV-A and visible spectral regions) very early and often in life induced melanomas.⁹