Cutaneous Nontuberculous Mycobacteria Infections Following Cosmetic Procedures: A Retrospective Study

Abstract

Background: Reports of skin infections associated with nontuberculous mycobacteria (NTM) following cosmetic procedures are increasing. The diagnosis and treatment of these infections remain a significant challenge for clinicians. Objective: We examined the clinical characteristics, microbiology, histopathology, and treatment strategies of NTM infections following cosmetic procedures, including botulinum toxin injection, lipolysis injection, hyaluronic acid injection, mesotherapy, autologous fat grafting, and other related procedures. Methods: This retrospective study of cosmetology-related cutaneous NTM infections diagnosed based on culture or molecular identification was conducted at a tertiary dermatology hospital in China. Demographic, clinical, microbiological, pathological biopsy, management, and outcome data were also collected. Results: The series enrolled 28 patients, four diagnosed by molecular identification and histology, and 24 by positive culture. All 24 NTM cultures were rapid-growing mycobacteria, mainly Mycobacterium abscessus complex (75%), with a mean time to positive culture of 11.8 days. The mean incubation period for the lesions was three weeks, while the mean time to diagnosis was 9.8 weeks. Treatment typically requires long-term, multi-drug therapy. Surgical intervention may shorten the disease course. Conclusion: Cosmetology-related cutaneous NTM infections are frequently underrecognized and challenging to diagnose, leading to delayed treatment. We aimed to enhance clinician awareness of NTM infections to facilitate early detection and prompt treatment. Empirical therapy with clarithromycin and moxifloxacin may be considered in the absence of susceptibility results, but treatment decisions should be carefully guided by susceptibility testing results. Surgical intervention may be beneficial, and tigecycline is a viable option when resistant to clarithromycin.