Methotrexate successful in treating resistant granulomatous foreign body reactions (GFBR) to dermal fillers

Methotrexate has been found to offer a low-risk therapeutic alternative in resistant and severe granulomatous foreign body reactions to non-biodegradable fillers. 

A study undertaken in the Department of Dermatology of Bordeaux University Hospital and published in the Journal of The European Academy of Dermatology and Venereology treated four women with severe, treatment-resistant GFBR for up to six months. 

The cases were treated with 10-15mg of either oral or subcutaneous methotrexate weekly. Adverse effects were monitored once weekly in the first month and then monthly in the remaining five months. 

The delay after injection of the filler material was from 17 to 30 years. Histological findings were consistent with GFBR to liquid injectable silicone in 2 cases, polymethylmethacrylate in 1 case and hydroxyethylmethacrylate in the last case.

Three patients developed a mild hepatic cytolysis (grade 1 or 2). Methotrexate could be maintained in those cases and was discontinued after six months in all cases. Two patients developed recurrence of lesions, at 28 months and nine months respectively after treatment stop, requiring reintroduction of treatment. The two other patients remained cleared after six months of follow‐up.