Embolia cutis medicamentosaT88.83
Synonym(s)
Dermite lividoid; livedoartige dermatitis; livedo-like dermatitis; Nicolau Syndrome; syndrome livédoid paralytic
HistoryThis section has been translated automatically.
Freudenthal, 1924; Nicolau, 1925
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.
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:
- Depotpenicillins
- Phenylbutazone-containing antirheumatic drugs
- Interferons
- Vaccines
- Glatiramer acetate (immunomodulator in MS).
Clinical featuresThis section has been translated automatically.
Minutes to a few hours after the i.m. injection painful, board-like infiltration with livedo racemosa-like skin markings (bizarre, tendril-like figures). Healing with hyperpigmentation. Central demarcation with formation of flat to sunken hemorrhagic necroses possible after 24-72 hours. Repulsion of the hemorrhagic scab. Development of deep ulcerations which heal with bizarrely shaped atrophic scars.
- 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.
Syringe abscess, livedo racemosa.
External therapyThis section has been translated automatically.
At the beginning of the therapy trial with glucocorticoid creams such as 0.1% triamcinolone cream(e.g. Triamgalen, R259 ) or 0.05% betamethasone V-lotio(e.g. Betnesol V, R030 ) or bland-drying with pasta zinci. After demarcation, removal of the necroses, wound cleansing, granulation-promoting measures, see below wound treatment.
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