Google Scholar Crossref Search ADS PubMed WorldCat 2 Soltani-Arabshahi R, Wong J, Duffy K, Powell D. Facial allergic granulomatous reaction and systemic hypersensitivity associated with microneedle therapy for skin rejuvenation, JAMA Dermatol 2014; 150: 68 - 72. Treatment approaches to facial granulomatous reactions previously described include potent topical, oral or intralesional steroids, hydroxychloroquine and methotrexate.[4] The patient is now doing well after 6 months of methotrexate. A 28-year-old Afro-Caribbean woman underwent a second facial microneedling procedure to improve skin texture.