Foreign body granuloma in Adult
Alerts and Notices
Synopsis
Foreign body granuloma can occur at any age and initially begins with acute inflammation at the site of entry of the foreign material. This is often followed by apparent resolution of the lesion. However, after a period of weeks, months, or even years, a chronic inflammatory reaction can ensue, presenting as a red or red-brown, inflamed, indurated papule, plaque, or nodule. Additional clinical findings may include cellulitis, abscess, edema, ulceration, and erythema.
The formation of a foreign body granuloma begins with neutrophils attracted to the site of entry. When the neutrophils are unable to engulf the foreign material, macrophages are attracted to the site. Macrophages become active and secrete cytokines once they have phagocytosed the foreign material. The secreted cytokines attract more macrophages and peripheral monocytes to the site of entry, and this process forms a chronic granuloma. Macrophages may fuse together to form multinucleated giant cells.
There are numerous causes of foreign body granuloma:
- Tattoo inks
- Paraffin
- Silicone (polydimethyl siloxane) liquid or gel
- Silica
- Talc
- Zirconium
- Beryllium
- Aluminum
- Zinc
- Other synthetic fillers, eg, poly-L-lactic acid, polymethylmethacrylate
- Hair keratin
- Pseudofolliculitis barbae
- Acne keloidalis nuchae
- 75% of sacrococcygeal pilonidal cysts
- Nail keratin
- Hair
- Bovine collagen
- Hyaluronic acid
- Starch
- Cactus spines
- Jellyfish and corals
- Sea urchin spines
- Silk sutures
- Corticosteroids
- Nylon or polypropylene sutures (used less frequently)
Accidental
- Wood splinters
- Cactus spines
- Blast injury
- Motor vehicle accident
- Talc or starch powders from surgical gloves
- Surgical sutures
- Laparoscopic gallbladder removal
- Gelfoam
- Aluminum chloride
- Ferric subsulfate (Monsel's solution)
- Hyaluronic acid fillers
- Bovine collagen fillers
- Silicone
- Paraffin for tissue augmentation
- Red pigment: cinnabar / mercuric sulfide (most common cause of granulomatous tattoo reaction)
- Blue pigment: cobalt
- Green pigment: chromium
- Yellow pigment: cadmium
- Purple pigment: manganese
- Black pigment: carbon (India ink)
- Brown pigment: ferric oxide
- White pigment: titanium or zinc oxide
- Zirconium oxide in deodorants and antipruritus preparations
- Intravenous drug users
- "Barber's interdigital pilonidal sinus" refers to the reaction surrounding an entrapped cut or shaved hair, often seen in an interdigital space of a barber's hand. These cases represent foreign body granulomas rather than true cysts.
Codes
ICD10CM:L92.3 – Foreign body granuloma of the skin and subcutaneous tissue
SNOMEDCT:
3310005 – Foreign body granuloma of skin
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Basal cell carcinoma
- Cellulitis
- Abscess
- Lobular capillary hemangioma (pyogenic granuloma)
- Sarcoidosis
- Other cutaneous granulomas
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Last Reviewed:11/10/2021
Last Updated:11/10/2021
Last Updated:11/10/2021
Patient Information for Foreign body granuloma in Adult
Overview
A foreign body granuloma is your skin's reaction to the presence of something that isn't normally found there. This can look like a red or red-brown bump or patch where the foreign body has entered the skin. The reaction can develop hours, weeks, and even years after the object enters the skin, making it difficult to diagnose.Foreign body granulomas be caused by a lot of triggers, most commonly:
- Damaged hair follicle
- Cyst
- Acne
- Ingrown hair
- Ingrown nail
- Splinters
- Tattoo ink
- Surgery
- Intravenous drugs
Who’s At Risk
Anyone can develop a granuloma.Signs & Symptoms
A foreign body granuloma will look like a bump, lump, or scaly patch where the foreign object entered the skin.Self-Care Guidelines
Avoid close shaving, especially near acne bumps.When to Seek Medical Care
Consult with your doctor if you develop a bump or patch on your skin at the site of a puncture wound or a common trigger, such as inside a tattoo.Treatments
Your doctor will remove of the granuloma and the foreign body that is causing it, if possible. If the area is swollen, your doctor may prescribe a corticosteroid cream.Laser therapy may be an option to treat large granulomas inside tattoos.
Foreign body granuloma in Adult