How to cite this article: Sriram S, Tuknayat A. Nicolau syndrome. CosmoDerma 2021;1:30.
A 55-year-old woman presented with a sudden onset, painful, large violaceous patch with sharp angulated margins and reticulate pattern over a the left side of the body which started 2 days after an intramuscular injection of diclofenac [Figure 1].
Nicolau syndrome is a rare cutaneous drug reaction which occurs at the site of an intramuscular drug injection. The patient experiences severe pain around the injection site immediately after injection which is then rapidly followed by erythema, a livedoid reticular patch, or a hemorrhagic patch. The suggested pathogenesis was that it occurs due to accidental intra-arterial injection which causes direct embolism of the drug. Other suggested pathogenesis includes crystallization of aqueous drugs in vessels and arteriovenous shunt development or ischemia following a para-arterial injection.
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