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Livedoid dermatitis

Painful discoloring skin reaction to drug injection

Summary

Painful discoloring skin reaction to drug injection

Field	Value
synonym	Embolia cutis medicamentosa, Nicolau syndrome
image	Redness and swelling in a foot caused by livedoid dermatitis.png
caption	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") 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, intravenous, and intraarticular injections. 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.

Pathogenesis

The cause of this condition is poorly understood. Microscopic examination of affected tissue shows ischemic necrosis, 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

The diagnosis is mainly clinical. Skin biopsies of the site show necrosis caused by ischemia. Radiographic imaging may help to delineate the extent of the wound.

Treatment

Depending 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.

References

James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. {{ISBN. 0-7216-2921-0.
(2005). "Embolia cutis medicamentosa after subcutaneous injection of pegylated interferon-α". Hautarzt.
(2007). "Embolia cutis medicamentosa following subcutaneous injection of glatiramer acetate". J Dtsch Dermatol Ges.
(1999). "Embolia cutis medicamentosa of the foot after sclerotherapy". Eur J Dermatol.
(2003). "Nicolau's syndrome after local glucocorticoid injection". Joint Bone Spine.
(Jul–Dec 2009). "Nicolau Syndrome: An Iatrogenic Cutaneous Necrosis". J Cutan Aesthet Surg.
(2005). "Localized retiform purpura after accidental intra-arterial injection of polidocanol". Acta Dermatol Venereol.

Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

drug-eruptions vascular-related-cutaneous-conditions

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