Abstract

The use of vitamin E facial microneedling and injection for rejuvenation purposes is sometimes associated with local and sometimes systemic complications. We present a 44-year-old female with a 4-month progressively enlarging necrotic midline chin ulcerative skin lesion that started as a painful oozing chin mass for several months following use of a microneedling device. Despite the use of antibiotics and debridement, no clinical improvement was appreciated. A repeat biopsy after 3 months shows diffuse lymphohistiocytic and eosinophilic inflammation within the dermis with poorly defined granulomas and multinucleated giant cells containing exogenous material. Similar detached exogenous material is also identified adjacent to the tissue. The dermis demonstrates diffuse re-epithelialization with pseudoepitheliomatous hyperplasia in association with the inflammatory process and granulation tissue. Ancillary studies PAS, GMS, AFB, Fite, and Giemsa and pan-cytokeratin are negative for microorganisms and invasive carcinoma. The overall findings are consistent with a foreign body reaction to an exogenous material such as vitamin E oil. Intralesional steroid injection is initiated with progressive and drastic improvement. Facial rejuvenation with vitamin E injection can be associated with severe complications including local, sometimes systemic, and life-threatening ones. Even though there has not been a standard treatment for the associated complications, with the recent increase in reported complications, it is important to be vigilant to correlate clinical background and history of recent cosmetic procedures with the non-specific histologic findings for prompt diagnosis and timely treatment.