| Livedoid dermatitis | |
|---|---|
| Other names | Embolia cutis medicamentosa, Nicolau syndrome |
 | |
| Feet affected by livedoid dermatitis | |
| Specialty | Dermatology |
Livedoid dermatitis is a iatrogenic cutaneous reaction that occurs immediately after a drug injection. It presents as an immediate, extreme pain around the injection site, with overlying skin rapidly becoming erythematous, violaceous, or blanched ("ischemic pallor")[1]:โ124โ and sometimes with reticular pattern. The reaction eventually leads to variable degrees of necrosis to the skin and underlying tissue. The wound eventually heals, but can lead to atrophic, disfiguring scarring.
The reaction is associated with a range of both injection sites and drugs. It was first reported by Freudenthal in 1924 following an injection of bismuth salts for syphilis. Although initial reports were following intramuscular injections, the reaction has since also been reported following subcutaneous,[2][3] intravenous,[4] and intraarticular injections.[5] Livedoid dermatitis has been reported to occur with many different drug injections, including: penicillins, local anesthetics (e.g. lidocaine), vaccines (e.g. Dtap), corticosteroids, NSAIDs, and more.[6]
Pathogenesis
editThe cause of this condition is poorly understood. Microscopic examination of affected tissue shows ischemic necrosis,[7] and so various hypotheses exist to explain this ischemia, including vasospasm from needle prick, the injected drug, or cold compresses applied to the wound.
Diagnosis
editThe diagnosis is mainly clinical. Skin biopsies of the site show necrosis caused by ischemia.[7] Radiographic imaging may help to delineate the extent of the wound.
Treatment
editDepending on the extent and state of infection of the wound, the condition may require antibiotics, wound debridement in early stages, and corrective plastic surgery in late stages.[6]
See also
editReferences
edit- ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBNย 0-7216-2921-0.
- ^ Sonntag, M; Bruch-Gerharz D; Neumann NJ; Hodzic-Avdagic N (2005). "Embolia cutis medicamentosa after subcutaneous injection of pegylated interferon-ฮฑ". Hautarzt. 56 (968โ969): 968โ969. doi:10.1007/s00105-005-1026-2. PMIDย 16142495. S2CIDย 22688473.
- ^ Harde V; Schwarz T (2007). "Embolia cutis medicamentosa following subcutaneous injection of glatiramer acetate". J Dtsch Dermatol Ges. 5 (12): 1122โ1123. doi:10.1111/j.1610-0387.2007.06391.x. PMIDย 18042092. S2CIDย 23425336.
- ^ Geukens J; Rabe E; Bieber T (1999). "Embolia cutis medicamentosa of the foot after sclerotherapy". Eur J Dermatol. 9 (2): 132โ133. PMIDย 10066964.
- ^ Cherasse A; Kahn MF; Mistrih R; Maillard H; Strauss J; Tavernier C (2003). "Nicolau's syndrome after local glucocorticoid injection". Joint Bone Spine. 70 (5): 390โ392. doi:10.1016/s1297-319x(03)00137-4. PMIDย 14563471.
- ^ a b Nischal KC; Basavaraj HB; Swaroop MR; Agrawal DP; Sathyanarayana BD; Umashankar NP (JulโDec 2009). "Nicolau Syndrome: An Iatrogenic Cutaneous Necrosis". J Cutan Aesthet Surg. 2 (2): 92โ95. doi:10.4103/0974-2077.58523. PMCย 2918347. PMIDย 20808597.
- ^ a b Yebenes M; Gilaberte M; Toll A; Barranco C; Pujol RM (2005). "Localized retiform purpura after accidental intra-arterial injection of polidocanol". Acta Dermatol Venereol. 85 (4): 372โ373. doi:10.1080/00015550510027856. PMIDย 16191871.
