Topic
Livedoid dermatitis
About: Livedoid dermatitis is a research topic. Over the lifetime, 25 publications have been published within this topic receiving 259 citations. The topic is also known as: Nicolau syndrome & Embolia cutis medicamentosa.
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TL;DR: Subcutaneous injection, rather than intramuscular injection, was found to be a determining factor in this case and Clinicians must be cautious in the use of proper injection procedures, including appropriate needle length, in order to minimise complications.
Abstract: Nicolau syndrome (livedoid dermatitis) is a rare adverse reaction of a still largely unidentified pathogenesis at the site of intramuscular drug injection. The typical presentation is pain around the injection site soon after injection, followed by erythema, livedoid patch, haemorrhagic patch, and finally necrosis of skin, subcutaneous fat, and muscle tissue. The phenomenon has been related to the administration of a variety of drugs, including non-steroidal anti-inflammatory drugs, corticosteroids, and penicillin. We report a case of Nicolau syndrome following an intramuscular injection of diclofenac. The large ulceration over the right buttock was positive for Pseudomonas aeruginosa, and histology revealed subcutaneous fat necrosis and non-specific inflammation with no evidence of malignancy or vasculitis. The lesion required multiple debridements and a partial-thickness skin graft. Subcutaneous injection, rather than intramuscular injection, was found to be a determining factor in this case. Clinicians must be cautious in the use of proper injection procedures, including appropriate needle length, in order to minimise complications.
66 citations
TL;DR: A case of a seven-year-old boy with diagnosis of NS after intramuscular benzathine penicillin injection to the ventrolateral aspect of the left thigh is described, complicated by rapid progression of compartment syndrome of the lower limb proceeding to acute renal failure and death.
Abstract: Nicolau syndrome (NS) is a rare complication of an intramuscular injection characterized by severe pain, skin discoloration, and varying levels of tissue necrosis. The case outcomes vary from atrophic ulcers and severe pain to sepsis and limb amputation. We describe a case of a seven-year-old boy with diagnosis of NS after intramuscular benzathine penicillin injection to the ventrolateral aspect of the left thigh. Characteristic violaceous discoloration of skin and immediate injection site pain identified it as a case of NS. The case was complicated by rapid progression of compartment syndrome of the lower limb, proceeding to acute renal failure and death. Associated compartment syndrome can be postulated as a poor prognostic factor for NS.
48 citations
TL;DR: Three patients with Nicolau syndrome in the buttocks following diclofenac intramuscular injection complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks.
Abstract: Nicolau syndrome is a rare complication of intramuscular injection consisting of ischemic necrosis of skin, soft tissue, and muscular tissue that arises locoregionally. The characteristic pattern is pain around the injection site, developing into erythema, a livedoid dermatitis patch, and necrosis of the skin, subcutaneous fat, and muscle tissue. Three patients were injected with drugs (diclofenac sodium, ketoprofen, meperidine) for pain relief. Three patients complained of pain, and a skin lesion was observed, after which necrosis developed on their buttocks. Each patient underwent debridement and coverage. The wound healed uneventfully. We report three cases of Nicolau syndrome in the buttocks following diclofenac intramuscular injection.
38 citations
TL;DR: A 3-year-old boy with diagnosis of Nicolau syndrome after intramuscular benzathine penicillin injection to the midanterior part of the left thigh recovered with no sequelae.
Abstract: Nicolau syndrome (livedoid dermatitis) is a very rare complication of intramuscular injections and manifests as excruciating pain immediately after injection. We describe a 3-year-old boy with diagnosis of Nicolau syndrome after intramuscular benzathine penicillin injection to the midanterior part of the left thigh. He was treated with hyberbaric oxygen and pentoxyphilline in addition to supportive treatment and recovered with no sequelae.
37 citations
TL;DR: The first case of delayed NLD after ultrasoundguided injection of polidocanol foam is reported, and surprisingly, pain and signs of cutaneous ischemia happened after 4 symptom-free days.
Abstract: Nicolau’s livedoid dermatitis (NLD) is a rare adverse effect of intramuscular injection. Pain at the site of injection is acute, massive, and immediate. It precedes the occurrence of a livedoid plaque that usually evolves toward skin necrosis. We report the first case of delayed NLD after ultrasoundguided injection of polidocanol foam. Surprisingly, pain and signs of cutaneous ischemia happened after 4 symptom-free days. Under steroid and heparin therapies, the patient healed without sequelae.
18 citations