What are the other Names for this Condition? (Also known as/Synonyms)

• FBG (Foreign Body Granuloma)

What is Foreign Body Granuloma? (Definition/Background Information)

• Foreign Body Granuloma (FBG) may be described as a benign inflammatory (granulomatous) change involving the tissues, usually skin tissue, caused by the presence of a foreign body in the tissue. The foreign body may be categorized as endogenous (of internal origin such as hair shafts or cyst contents) or exogenous (of external origin such as splinters, tattoos, or silica)
• The foreign object/agent may be introduced into the body intentionally, unintentionally, or accidently, such as through a surgery (sutures or implants), from self-inflicted wounds, or from a vehicular accident
• The signs and symptoms of Foreign Body Granuloma are dependent on the underlying cause, composition of the foreign body, entry point into the body, the quantity/amount of foreign material introduced, and the body part affected. In many individuals, the condition results in papules and nodules that harden over time
• Following a diagnosis of the condition, Foreign Body Granuloma may be treated via surgery, where possible, and appropriate symptomatic treatment. With suitable management of the condition, the outcomes are improved; nevertheless, Foreign Body Granuloma may take many months and years to resolve/heal completely

Who gets Foreign Body Granuloma? (Age and Sex Distribution)

• Foreign Body Granuloma may affect individuals of any age category; both children and adults may be affected
• Both males and females are affected
• Worldwide, individuals of all racial and ethnic background may be affected

What are the Risk Factors for Foreign Body Granuloma? (Predisposing Factors)

The following offending agents or events (risk factors) have been identified for Foreign Body Granuloma. These are categorized accordingly as:

• Iatrogenic (from medical procedures):
  • Sutures
  • Surgical tapes and adhesives
  • Silicone implants and gels
  • Bovine collagen fillers
  • Hyaluronic acid fillers
  • Paraffin injections
  • Powder dust from surgical gloves
  • Surgical site applications such as Monsel’s solution
  • Talc (in dusting powders)
  • Intralesional corticosteroid injections
  • Vaccinations causing the introduction of silicates into the body
• Traumatic or injury-based:
  • Gunshot wounds
  • Wood splinters and broken glass wounds
  • Shrapnel from explosives
  • Animal bites, fish spines, or insect stings causing broken teeth or stingers to remain in the body
  • Exposure to thorny plants and cactus spines
  • Road accidents/motor vehicle accidents
• Occupational or work-based:
  • Construction work
  • Carpentry
  • Metals such as zinc, aluminum, beryllium, etc.
  • Barbers, hair groomers, and beauticians
• Inadvertent or intentional (self-inflicted):
  • Tattoos (introduction of inks and pigments)
  • Use of recreational drugs (intravenous and subcutaneous injections)
  • Certain foods
  • Topical applications containing zirconium
  • Cosmetics - skin bleaching agents, lipids, injectable fillers, etc.
• Endogenous agents (body components reacting with a specific part of the body)
  • Nail (keratin)
  • Hair follicle
  • Cyst rupture leading to spilling of contents (such as traumatized epidermal cysts)
  • Urate crystals

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Foreign Body Granuloma? (Etiology)

• Foreign Body Granuloma develops as an inflammatory reaction of the body (usually skin tissue) in response to an exogenous or endogenous foreign material introduced into the body tissue
• The development of signs and symptoms depend on the type of foreign material involved (including composition and size/quantity of the foreign body), entry mode, part of the body involved, and its response to the introduced material

What are the Signs and Symptoms of Foreign Body Granuloma?

The signs and symptoms of Foreign Body Granuloma may widely vary from one individual to another. It depends on the foreign material (offending agent) involved, affected body part, the method of introduction of the foreign material into the body, and the time/duration the introduced material stays in the body. An acute inflammatory reaction may be initially observed, which may then resolve. Following a period of time (days, weeks, or months), a chronic inflammatory response may be noted.

The signs and symptoms of Foreign Body Granuloma may include:

• Presence of papules, plaques, and nodules
• The granulomatous skin lesions may range in color from pink, red, violet, brown, or black (skin pigmentary changes)
• The lesions may be located anywhere on the body; the involved part of the body may present edema (diffusely swollen firm tissue from local fluid accumulation)
• Sometimes, the lesions may present pain, itching, and burning sensation
• Lesions may ulcerate and bleed or discharge fluids
• Abscess formation
• The skin lesions may harden and result in fibrosis

Additional signs and symptoms of any associated condition may be noted.

How is Foreign Body Granuloma Diagnosed?

A diagnosis of Foreign Body Granuloma is reportedly difficult and challenging. The diagnostic tests and procedures may include:

• A thorough medical history and physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Microscopic examination with polarized light
• Energy-dispersive X-ray analysis (EDXA)
• Electron energy loss spectroscopy (EELS)
• Laser microprobe mass analysis
• Infrared spectrophotometry
• Imaging studies, such as ultrasound, CT, or MRI scans, as required
• Tissue biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Tests and procedures to diagnose the associated condition, if any present, is important.

A differential diagnosis to eliminate other skin conditions may be needed before arriving at a definitive diagnosis. These may include:

• Actinic granuloma
• Cutaneous sarcoidosis
• Granuloma annulare
• Granuloma faciale
• Granuloma inguinale
• Granulomatous dermatitis
• Majocchi granuloma
• Pyogenic granuloma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Foreign Body Granuloma?

Foreign Body Granuloma may cause the following complications:

• Some individuals may have concerns regarding their appearance, especially if it involves the face and neck
• Bleeding and ulceration of the skin lesions (from scratching) can result in superimposed bacterial and fungal infections
• Permanent scarring and hardening of skin
• The foreign material may be transported to other sites (such as local lymph nodes) via the lymphatic system, resulting in further worsening of the granulomatous condition
• Persistence of the condition for a long time (several years)
• Treatment complications

Complications of the underlying/associated condition, if any, may be noted.

How is Foreign Body Granuloma Treated?

The treatment of Foreign Body Granuloma primarily involves managing the underlying/associated causative condition, which may vary based on the cause. The treatment measures may include:

• In many cases, a surgical removal (excision) of the foreign body may be attempted, following its diagnosis
• Superimposed bacterial infections may be treated using antibiotics
• Topical steroid lotions and creams may be used for skin lesions
• Injections of corticosteroid into the area of inflammation can diminish the response
• Use of medications such as retinoids, allopurinol, and colchicine
• Dermabrasion: Abrading the superficial skin lesions using a special equipment
• Cryotherapy, where cold temperatures are used to destroy the skin lesions
• Phototherapy, where light is used to treat the skin condition

Generally, proper follow-up care with regular screening and check-ups are important and encouraged.

How can Foreign Body Granuloma be Prevented?

The preventative measures for Foreign Body Granuloma include mitigating the risk factors, where possible. This may include:

• Undertaking early and appropriate treatment of any health condition
• Avoiding accidents or injuries, where possible, such as by using seat belts or protective gear, as applicable
• Stopping the use of recreational drugs
• Being careful while outdoors, or while handling animals and insects

What is the Prognosis of Foreign Body Granuloma? (Outcomes/Resolutions)

• The prognosis for Foreign Body Granuloma is good with appropriate treatment. Some cases are known to resolve spontaneously, even in the absence of treatment
• However, in some individuals, the condition may persist for several years to decades and may become a chronic medical issue

Additional and Relevant Useful Information for Foreign Body Granuloma:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse

Avoid scratching or picking the skin lesions, which may lead to additional complications, such as superimposed infections