Silicone-induced granulomas successfully treated with adalimumab.

Since silicone is a permanent filler, inflammatory reactions can occur even several years after its injection. Clinical and pathologic features of silicone granulomatous reaction (SG) are variable. Delayed granulomatous reactions to non-biodegradable fillers are often refractory to treatment.Pathogenesis of SG formation remains unclear. Immunologic cross-reaction with T-cell and macrophage activation with release of cytokines, such as interferon gamma and tumor necrosis factor alpha (TNF-α) have been proposed. This may be triggered by a granulomatous response to secondary-site events.Adalimumab is an IgG1 monoclonal antibody whose origin is completely human. It has demonstrated efficacy and safety in the treatment of other granulomatous skin diseases. Nevertheless, the role of anti-TNF drugs in the treatment of SG remains barely understood. In the literature, etanercept has been shown to be effective in two cases of factitial panniculitis.Herein, we report a case of granulomatous foreign body reaction to cosmetic filler treated with adalimumab with complete clinical response maintained over time, fact, to our knowledge, not previously reported in the literature. Both the initial rapid response and the favorable therapeutic duration were similar to those of the best therapeutic options reported. Consequently, anti-TNF therapy could be an interesting option for managing this entity.