Abstract

Hyaluronic acid is one of the ingredients widely used in cosmetic fillers. Although not many cases have been reported, these fillers can have unanticipated side effects in a different location and time. We report a case of a right lower eyelid lump with a clinical concern for infectious or depositional disorder, was actually due to a granulomatous reaction caused by the migration of hyaluronic acid filler. A 66-year-old female presented with a linear horizontal lump under her right lower eyelid. The patient denied numbness, changes in vision, eye pain, respiratory problem, or bruising. The clinical concern was for sarcoidosis, leprosy and amyloidosis and a punch biopsy was obtained. The hematoxylin and eosin stained sections showed dermal aggregates of mucin with surrounding granulomatous inflammation. The aggregates of mucin were positive for colloidal iron stain and Alcian blue pH 2.5 but was lost on Alcian blue pH 2.5 with hyaluronidase digestion. The mucin aggregates appeared to show some focal, weak staining for mucicarmine. Amyloid was not identified, including on Congo red stain. No acid-fast bacilli was identified on AFB stains. The findings were consistent with exogenous hyaluronic acid with associated granulomatous inflammation. On the follow up visit, the patient admitted receiving cosmetic filler around the glabella region several months ago. Dermatologists need to be aware of filler migration and its complications as they may present as a mass lesion at distant sites after a prolonged time period, raising suspicion for an inflammatory disorder, infectious process or depositional disorder.

Financial Disclosure:
No current or relevant financial relationships exist.