Subscribe to RSS
DOI: 10.1055/s-0042-1748644
Chronic Infection and Nodule Formation following Deoxycholate Injection
Abstract
Aqualyx (Marllor International Ltd, Rimini, Italy) was originally developed in Italy by Professor Pasquale Motolese and has been commercially available since 2009. It is a deoxycholate, aqueous gelatinous solution mixed with saline and buffering compounds. It is the only drug approved by the European Union for the reduction in localized fat. Aqualyx is sold exclusively to doctors and nurses trained in intralipotherapy. In the case of our patient, the product administered was advertised as Aqualyx, but was not administered by a trained health professional and was administered too superficially. The patient developed severe pain following the injection and was unable to sit for several weeks. There was localized skin necrosis, and palpable collections where the injection was administered. Our initial suspicion was development of an abscess or hematoma. To characterize further, we arranged an ultrasound scan that showed a “superficial hypoechoic lesion” but no deeper infection or spread. The numerous painful nodules ruptured onto the skin surface, resulting in purulent and bleeding lesions. This case demonstrates the importance of appropriate training and competence in performing cosmetic procedures including injections and fat dissolving treatments.
Author Contributions
Conceptualization: S.S. and F.A.-H. Funding acquisition: No funding for study. Methodology: S.S. and F.A.-H. Writing-original draft: S.S. and F.A.-H. Writing-review and editing: S.S. and F.A.-H.
Patient Consent
The patient provided written informed consent for the publication and the use of images.
Publication History
Article published online:
27 May 2022
© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Rittes PG. The use of phosphatidylcholine for correction of lower lid bulging due to prominent fat pads. Dermatol Surg 2001; 27 (04) 391-392
- 2 Rotunda AM, Suzuki H, Moy RL, Kolodney MS. Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution. Dermatol Surg 2004; 30 (07) 1001-1008
- 3 Rauso R, Salti G. A CE-marked drug used for localized adiposity reduction: a 4-year experience. Aesthet Surg J 2015; 35 (07) 850-857
- 4 Sykes JM, Allak A, Klink B. Future applications of deoxycholic acid in body contouring. J Drugs Dermatol 2017; 16 (01) 43-46
- 5 Rauso R, Rusciani A, Curinga G. An adipocitolitic aqueous micro-gelatinous solution for buffalo hump deformity reduction. J Drugs Dermatol 2014; 13 (10) 1282-1284
- 6 Pinto H, Hernandez C, Turra C, Manzano M, Salvador L, Tejero P. Evaluation of a new adipocytolytic solution: adverse effects and their relationship with the number of vials injected. J Drugs Dermatol 2014; 13 (12) 1451-1455
- 7 Shridharani SM. Injection of an adipocytolytic agent for reduction of excess periaxillary fat. Aesthet Surg J 2019; 39 (12) NP495-NP503
- 8 Humphrey S, Sykes J, Kantor J. et al. ATX-101 for reduction of submental fat: a phase III randomized controlled trial. J Am Acad Dermatol 2016; 75 (04) 788-797
- 9 Liu M, Chesnut C, Lask G. Overview of Kybella (deoxycholic acid injection) as a fat resorption product for submental fat. Facial Plast Surg 2019; 35 (03) 274-277
- 10 Lindsey SF, Benesh G, Pavlis J, Zaiac M. Deoxycholic acid injections for the treatment of infraorbital fat pads. Dermatol Surg 2019; 45 (12) 1720-1723
- 11 Dayan SH, Humphrey S, Jones DH. et al. Overview of ATX-101 (deoxycholic acid injection): a nonsurgical approach for reduction of submental fat. Dermatol Surg 2016; 42 (01, Suppl 1): S263-S270
- 12 Humphrey S, Femmer P, Beleznay K, Carruthers JDA. Deoxycholic acid for submental fullness and more: real-world experience with 202 patients. Dermatol Surg 2019; 45 (04) 624-627
- 13 Behr K, Kavali CM, Munavalli G. et al. ATX-101 (deoxycholic acid injection) leads to clinically meaningful improvement in submental fat: final data from CONTOUR. Dermatol Surg 2020; 46 (05) 639-645
- 14 Sung CT, Lee A, Choi F, Juhasz M, Mesinkovska NA. Non-submental applications of injectable deoxycholic acid: a systematic review. J Drugs Dermatol 2019; 18 (07) 675-680
- 15 Di Toro G, Rauso R. Skin necrosis following adipocitolitic solution injections. Aesthet Surg J 2016; 36 (02) NP74-NP76
- 16 Lindgren AL, Welsh KM. Inadvertent intra-arterial injection of deoxycholic acid: a case report and proposed protocol for treatment. J Cosmet Dermatol 2020; 19 (07) 1614-1618
- 17 Grady B, Porphirio F, Rokhsar C. Submental alopecia at deoxycholic acid injection site. Dermatol Surg 2017; 43 (08) 1105-1108
- 18 Souyoul S, Gioe O, Emerson A, Hooper DO. Alopecia after injection of ATX-101 for reduction of submental fat. JAAD Case Rep 2017; 3 (03) 250-252
- 19 Riswold K, Flynn V. A cautionary tale: a vascular event with deoxycholic acid injection. Dermatol Surg 2018; 44 (06) 887-889
- 20 Sachdev D, Mohammadi T, Fabi SG. Deoxycholic acid-induced skin necrosis: prevention and management. Dermatol Surg 2018; 44 (07) 1037-1039
- 21 Fagien S, McChesney P, Subramanian M, Jones DH. Prevention and management of injection-related adverse effects in facial aesthetics: considerations for ATX-101 (deoxycholic acid injection) treatment. Dermatol Surg 2016; 42 (01, Suppl 1): S300-S304
- 22 Save Face.. Laws and Regulations of the Non-surgical Cosmetic Industry. Accessed April 9, 2022 at: https://www.saveface.co.uk/laws-regulations-non-surgical-cosmetic-industry/