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World J Dermatol. May 2, 2015; 4(2): 103-107
Published online May 2, 2015. doi: 10.5314/wjd.v4.i2.103
Nicolau syndrome: A literature review
Kwang-Kyoun Kim, Dong-Sik Chae
Kwang-Kyoun Kim, Department of Orthopedic Surgery, Konyang University Hospital, Daejeon 302-718, South Korea
Dong-Sik Chae, Department of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon 404-834, South Korea
Author contributions: Kim KK have contributed to the paper as study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision; Chae DS have contributed to the paper as study acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision.
Conflict-of-interest: There is no conflict-of-interest in this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong-Sik Chae, MD, Assistant Professor of Orthopedic Surgery, Department of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon 404-834, South Korea. drchaeos@gmail.com
Telephone: +82-32-2903878 Fax: +82-32-2903879
Received: September 29, 2014
Peer-review started: October 1, 2014
First decision: November 14, 2014
Revised: February 10, 2015
Accepted: March 18, 2015
Article in press: March 20, 2015
Published online: May 2, 2015
Abstract

Nicolau syndrome (NS) is a rare cutaneous adverse reaction after intra-muscular or intra-articular injection. Clinical features of NS are presented by three typical phases (initial, acute and necrotic phases). The cause of NS is acute vasospasm, inflammation of arteries and thromboembolic occlusion of arteriole related various drugs. Many results of laboratory test, imaging studies and histopathology are reported and are associated with disease status. Three phase treatment is recommended for the patients with NS. Initially pain control and rule out differential diagnosis and in acute phase steroid therapy, heparin and pentoxifylline are useful. In necrotic phase, surgical treatment is needed depending on size of the affected site. NS is not well understood so far, however three phase treatment could lead to good result on basis of literature review.

Keywords: Nicolau syndrome, Livedoid dermatitis, Embolia Cutis Medicamentosa, Drug hypersensitivity, Dermatitis, Diclofenac

Core tip: To our knowledge, there is no literature review of nicolau syndrome (NS) and we report this review article for understanding NS.