CASE REPORT   

Giornale Italiano di Dermatologia e Venereologia 1999 December;134(6):607-11

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Silicone skin expanders and scleroderma. Critical analysis of the possible causal relationship and discussion of a clinical case

Passarini B., Bandini P., Calderoni O., Varotti C.

Università degli Studi - Bologna, Dipartimento di Medicina Clinica e Sperimentale, Sezione di Clinica Dermatologica

A case of quickly evolutive systemic scleroderma is described in a 34-year female patient 8 months after the surgical positioning of a skin expander following a right wide mastectomy in according to Madden due to infiltrative lobular and ductal breast carcinoma. The skin expander is a prosthesis temporary placed after breast demolitive surgery to mantain tissues elasticity, until the final prosthesis is applied. It is made of a silicone bag containing physiological solution. On the basis of the literature, it is suggested that the cutaneous lesion may be related to the skin expander: the clinical improvement, already evident after two months since expander removal, confirmed the hypothesis of the causal link between the two events. The role of silicone as a promoter of autoimmune pathologies is still debated (not only for scleroderma, but also for dermatomyositis and mixed connective disease): some authors claim this relationship still to be proved; others state that it is already well proved and identify also the related immunological mechanisms: prostheses would act as a continuous source of antigenic material, producing silicone debris, which spreads into the surrounding tissues, activating the macrophages to release PDGF and TGF molecules, inducing fibroblasts to produce collagen.