From New York City to Santiago, Chile, outbreaks of infections caused by difficult-to-treat bacteria — called mycobacteria — have been blamed on acupuncture and cosmetic injection procedures.
Experts say it’s a cautionary tale: Many cosmetic therapies are not well regulated. Many cosmetic technicians are unlicensed and do not follow proper needle sterilization techniques. And substances that are injected are sometimes contaminated. Consumers should be wary, and do their research, they say. “People have to ask themselves, ‘Do I really need and want this? Is the person providing this service licensed to do so?’ If you’re not completely comfortable with everything, I’d be very leery about getting an elective procedure like this,” says Reina M. Turcios, MD, an epidemiologist with the National Center for Infectious Diseases at the CDC, in a news release. The infection may not be apparent for months after the injection, researchers say. When it first appears, it looks like a pimple that gets bigger and drains pus. Then it opens and continues to drain pus. Serious complications have developed from the infections, and for some it has led to a hospital stay and surgery to drain infections. Many people have been left with large, permanent scars. “Injectibles can be safely and appropriately done by physicians properly trained in the art and technique,” says Seth A. Yellin, MD, director of the Emory Facial Center and chief of facial plastic surgery at Emory Healthcare in Atlanta. He agreed to comment on the reports. However, there is no regulation of the term “cosmetic,” Yellin tells WebMD. “The term ‘cosmetic surgery’ is a pseudo credential. You don’t have to take a class in anything. Literally, if you have an MD or DO … you can call yourself a cosmetic surgeon.” Cultural differences can complicate the picture, he says. Medical training is likely different from that required in the U.S. “Someone trained in acupuncture may genuinely think they are doing the right thing, just wiping a needle with alcohol when in fact that doesn’t kill this particular bacteria. They’re not trying to be deceitful, they’re just uneducated [in today's procedures].” The outbreaks are being discussed this week at the annual meeting of the Infectious Diseases Society of America, being held in San Diego, Calif. In New York City … Twenty-five skin infections were reported in people who had received cosmetic injections provided by unlicensed technicians — a Venezuelan couple who posed as doctors and set up several mobile treatment areas in hotel rooms and apartments, and were subsequently arrested, as reported in a news release. The couple reportedly used single-use sterile needles that they disposed after each use. Researchers suspect that the substances injected were contaminated. In the procedures, substances like silicone and collagen (to plump up tissue) and vitamin compounds (to rejuvenate skin) were injected. Also, an injection treatment called mesotherapy — performed to eliminate cellulite and body fat — was linked with the infection. The infections appeared a few days after injection, in the area that had been injected — face, buttocks, neck, hands, or breasts. Twelve patients were hospitalized for the infection, for up to three months. Two had surgery, because the infected area was so extensive. One woman developed a bloodstream infection. In all 25 cases, people ended up with scars in the injected area — face, buttocks, neck, hands, and breasts. “Unfortunately, this type of problem is continuing to happen as people have things done to make themselves look beautiful,” says researcher Turcios, who presented the report on this outbreak. “Many of these people set out to get rid of their wrinkles, and ended up with scars.”In Santiago, Chile … Fifty-one people who received mesotherapy injections at five cosmetic clinics developed skin abscesses; 23 developed abscesses that required draining and were treated with antibiotics. One woman was hospitalized. The injections were in the abdomen, back, buttocks, thighs, arms, and face — and left scars up to four inches long, says researcher Carlos M. Perez, MD, head of infectious disease at the Universidad Catolica de Chile, in a news release. Solutions used in the procedure tested negative for mycobacteria, leaving researchers uncertain about the source of infection. Although two of the five cosmetic clinics were well established, all have closed. “Mesotherapy is more common than you would imagine, particularly in South America,” says Perez. “People really need to avoid these kinds of unproven treatments for obesity.” In Toronto … Twenty-nine skin infections were linked to an acupuncturist treating people for pain and other health issues. The infections didn’t show up until months later, in some cases. In fact, some Toronto women did not notice the infection until five months later. Seven patients had 10 or more skin lesions. “The infection didn’t spread, but there’s the issue of appearance,” says researcher Elizabeth Phillips, with Sunnybrook & Women’s College Health Sciences Centre in Toronto, in a news release. “These infections are very slow to heal. Some of the women had [sores] for months and may be left with skin discoloration.” Because the infection can show up months after injection, neither doctors nor patients may link it to the injection, Phillips says. Find a Good Doctor “If you go to a reputable practitioner who practices standard sterile techniques, the likelihood of transmitting infectious material would be next to impossible,” says Yellin. “Injectibles can be safely and appropriately done by physicians properly trained in the art and technique.” How can you know if your cosmetic surgeon is respectable? That’s not always easy, he tells WebMD. The list of trained practitioners credentialed to perform plastic surgery includes facial plastic surgeons, dermatologists, and general practice plastic surgeons, Yellin says. His advice: “Like anything, it’s important to find a physician specially trained in the procedure you want. Otherwise, the practitioner may or may not have any experience. It’s a matter of asking the right questions — ‘How often do you do this procedure? What are your areas of expertise? What is your training?’ “When we’re talking about paramedical procedures or solutions that are not FDA-approved, you start entering into the unregulated world of cosmetic care,” Yellin says. “That’s when it’s buyer beware, you rely on ethics of individual, and you don’t know their training.” If you’re getting any medical treatment that requires a needle: Ask what medical board they belong to, and call that board. Call your state’s department of health to find out if certification is required; then check on a particular practitioner. Do some research on substances that would be injected. The American Academy of Medical Acupuncture offers certification or licensing; 34 states thus far have board requirements for acupuncturists. (Source: Infectious Diseases Society of America annual meeting, San Diego, Calif., Oct. 9-12, 2003. News release, Infectious Diseases Society of America. Seth A. Yellin, MD, director, Emory Facial Center; chief, facial plastic surgery, Emory Healthcare, Atlanta: WebMD Health News)