Causes of Granuloma Formation After Mesotherapy
Granuloma formation after mesotherapy is primarily caused by foreign body reactions to injected substances, infection with atypical mycobacteria, and improper injection techniques. 1, 2, 3
Foreign Body Reactions
- Foreign body-type granulomatous reactions occur when the immune system responds to injected substances that are recognized as foreign materials 1
- Unauthorized or unapproved substances used in mesotherapy solutions are a major risk factor for granuloma development 1, 3
- Dermal fillers and other injectable materials can trigger granuloma formation after a latent period of several months, typically appearing at all injected sites simultaneously 4
- Lipolytic cocktails used for fat reduction mesotherapy have been specifically associated with cutaneous foreign body granulomas 3
Infectious Causes
- Atypical mycobacterial infections, particularly with species like Mycobacterium massiliense, are significant causes of granuloma formation after mesotherapy 2
- These infections can be difficult to diagnose through standard cultures and often require molecular diagnostic techniques for proper identification 2
- Contaminated solutions, equipment, or inadequate skin preparation can introduce mycobacteria during the procedure 2, 5
- Bacterial infections may not only cause granulomas directly but can also trigger foreign body granulomas in patients with previously injected fillers 4
Technical and Procedural Factors
- Improper injection techniques including incorrect depth, volume, or distribution of injected materials can contribute to granuloma formation 6
- Excessive concentration of injected substances can increase the risk of granulomatous reactions 7, 6
- Repeated injections in the same area may increase the likelihood of granuloma development 6
- Unlicensed practitioners performing mesotherapy significantly increase the risk of adverse reactions including granulomas 5
Patient-Related Factors
- Individual immune system responses vary, with some patients being more susceptible to granulomatous reactions 4
- Pre-existing inflammatory skin conditions may predispose patients to granuloma formation 6
- History of previous hypersensitivity reactions to injectable substances increases risk 6
Prevention Strategies
- Only licensed practitioners should perform mesotherapy using FDA-approved substances 5
- Proper sterilization techniques and adherence to safe injection practices are essential 5
- Appropriate dilution of active substances and careful selection of injection sites can minimize risk 7, 6
- Thorough patient screening for history of hypersensitivity reactions or autoimmune disorders is recommended 6
Management of Established Granulomas
- Intralesional injection of corticosteroid crystals (triamcinolone, betamethasone, or prednisolone) is the first-line treatment for foreign body granulomas 4
- Corticosteroids can be combined with antimitotic drugs such as 5-fluorouracil to reduce the risk of skin atrophy 4
- For infected granulomas, appropriate antimicrobial therapy directed at the specific pathogen is essential 2
- Surgical excision should be considered only as a last resort due to the fingerlike growth pattern of granulomas into surrounding tissue 4
Understanding these causes is crucial for both prevention and appropriate management of granulomatous reactions after mesotherapy.