In the treatment of granulomas, surgical excision is not recommended
due to their poorly defined borders and the potential
for this approach to lead to fistulas, abscesses, or scars.9 Treatment
is geared toward stopping both the increased secretion of
interstitial substances and the invasion of cells.24 Approaches
include the administration of steroids (intralesional, intramuscular,
or systemic) with or without the coadministration of
immune-modulating medications.9 Intralesionally injected
5-fluorouracil, alone or in combination with triamcinolone
acetonide or betamethasone, are among other approaches
demonstrated to be highly effective (Table 324; Figure 3). In
addition, intense pulsed light can be a useful adjunct for the
treatment of engorged capillaries.9 Recurrence following the
successful treatment and resolution of granulomas is rare.9
SUMMARY
Injection-related AEs with the use of PLLA are generally transient
and typically resolve spontaneously. Most patients simply
need reassurance that the AEs will resolve on their own. To
summarize simply, papules and nodules represent an overabundance
of product with a predictable host reaction and
granulomas represent a profound overabundance of host reaction
to product. The occurrence of nodules, which are generally
nonvisible and asymptomatic, has been minimized through improved
methodology; if desired, they can be camouflaged via
the injection of HA or surgically excised.
