HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
Rare, circumscribed (in the injection area), painful, dendritic, infarct-like, sharply defined zosteriform skin necroses after intramuscular, rarely after intra-articular or subcutaneous injections.
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EtiopathogenesisThis section has been translated automatically.
Intra-arterial, possibly para-arterial injection of drugs to be injected intramuscularly. Pathogenetically, the intra-arterial injection causes vasospasm and fibrinoid necrosis of arterioles and capillaries with thrombosis of the terminal tract. Potentially triggering drugs:
- Phenylbutazone-containing antirheumatic drugs
- Glatiramer acetate (immunomodulator in MS).
Clinical featuresThis section has been translated automatically.
- Stage I: Edema extending beyond the injection area with inflammatory infiltration without necrosis.
- Stage II: Strong inflammatory reaction, macroscopically still no necrosis.
- Stage III: Necrosis of skin and/or muscles.
- Stage IV: Additional necrosis of organs of the small pelvis.
Differential diagnosisThis section has been translated automatically.
External therapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
- Antiphlogistic therapy with ibuprofen (e.g. ibuprofen stada, 2-3 times/day 200 mg p.o.). At the beginning, vasodilating agents such as pentoxifylline (e.g. Trental 2 times/day 600 mg p.o.), nicotinic acid (Merz Spezial Dragees N 3 times/day 2-3 Drg. p.o.) or papaverine derivatives such as moxaverine (e.g. Kollateral forte Drg., 2-3 times/day 1 Drg. p.o.) can be tried.
- Pain therapy with paracetamol (e.g. Ben-u-ron Tbl.) or possibly tramadol (e.g. Tramal Trp.).
- If necessary, prophylactic systemic broad-spectrum antibiotics, e.g. with Ofloxacin (e.g. Tavanic) 2 times/day 100-200 mg p.o., in case of superinfection antibiotics after antibiogram.
LiteratureThis section has been translated automatically.
- Beissert et al (1999) Embolia cutis medicamentosa (Nicolau syndrome) after intra-articular injection. dermatologist 50: 214-216
- Cherasse A et al (2003) Nicolau's syndrome after local glucocorticoid injection. Joint Bone Spine 70: 390-392
- Freudenthal W (1924) Local embolic bismogenol exanthema. Arch Dermatol Syph 147: 155-160
- Littmann K, Albrecht KH, Judge HJ, Eigler FW (1984) Embolia cutis. Dtsch med Wschr 109: 800-805
- Müller CSL et al (2016) Diagnostic and histological features of cutaneous vasculitis/vasculopathies. Act Dermatol 42: 286-301
- Nicolau S (1925) Dermatite livédoide et gangreneuse de la fesse consécutive aux injections intramusculaires dans la syphilis Speaking of a case of arterial bismuth embolism. Ann Mal Vén 20: 321-339
Incoming links (17)Angiomatosis diffuse cutaneous; Benzathine benzylpenicillin; Betamethasone valerate emulsion hydrophilic 0,025/0,05 or 0,1 % (nrf 11.47.); Coma bubbles; Dermatitis, livedo type; Embolism, arterial; Embolism, arterial; Livedoid vasculopathy; Livedo racemosa; Livedovasculopathy; ... Show all
Outgoing links (15)Antibiogram; Antibiotics; Anti-inflammatories; Betamethasone valerate; Betamethasone valerate emulsion hydrophilic 0,025/0,05 or 0,1 % (nrf 11.47.); Glucorticosteroids topical; Hyperpigmentation; Ibuprofen; Livedo racemosa (overview); Ofloxacin; ... Show all
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