Andrews et al1 report a very interesting case in the “Off-Center Fold” section. Their patient developed subcutaneous facial nodules and apple jelly–colored papules over her knees and right forearm. Fifteen years earlier she had received liquid silicone injections in several sites of her face. The biopsy specimen from the glabella showed a diffuse granulomatous infiltrate with multinucleated giant cells with vacuolated spaces, and the presence of silicone was demonstrated by energy-dispersive x-ray probe microanalysis. The biopsy specimen from the forearm showed granulomas composed of epithelioid histiocytes and giant cells with a mild lymphocytic infiltrate. Silicone was not detected in this specimen. In Figure 2 of the off-center fold,1 the lesions of the knees are clinically suggestive of papular sarcoidosis, and the elevated angiotensin-converting enzyme level, the computed tomographic scan of the chest, and the respiratory complaints suggest that this patient is developing systemic sarcoidosis.
Marcoval J, Mañá J. Silicone Granulomas and Sarcoidosis. Arch Dermatol. 2005;141(7):904. doi:10.1001/archderm.141.7.904-a
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