Livedoid dermatitis is a
iatrogenic cutaneous reaction that occurs immediately after a
drug injection
Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body (usually intravenously, but also at an intramuscular or Subcutaneous injection, subcutaneous l ...
. It presents as an immediate, extreme pain around the injection site, with overlying skin rapidly becoming
erythematous, violaceous, or blanched ("ischemic pallor")
[James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. .] and sometimes with reticular pattern. The reaction eventually leads to variable degrees of
necrosis
Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dig ...
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
Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, li ...
), vaccines (e.g. Dtap),
corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are in ...
s, NSAIDs, and more.
Presentation
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
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems ...
.
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.
See also
*
Injection site reactions
*
List of cutaneous conditions
Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the body and composed of skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier agai ...
References
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Drug eruptions
Vascular-related cutaneous conditions