Nicolau syndrome: A literature review

Table 1 Clinical features and three phase treatment of nicolau syndrome

Phase	Clinical features	Treatment
Initial	Intense pain	Analgesics
	Erythema	Systemic antibiotics1
	Radiating pain	No ice pack
	Faintness, syncope
Acute	Livedoid plaque	Systemic steroid
	Violaceous patch	Anticoagulant agent
	Non-necrotic
Necrotic	Necrotic indurated plaque	Surgical debridement
	Ulceration with necrosis	Plastic surgery

¹Systemic antibiotics: Until rule out cellulitis.

Table 2 Drug list related to nicolau syndrome

Drug	Target disease or symptom of using drug	Ref.	Duration of necrosis	Affected site
Naltrexone	Alcohol dependency	Perli et al[25]	Over 7 d	Buttock
Etanercept	Psoriatic arthritis	Guarneri et al[21]	10 d	Abdomen
Ketorolac	NS	Marangi et al[26]	2 wk	Buttock
Ketoprofen	Knee pain	Kim et al[27]	NS	Buttock
	COM	Lee et al[28]
Meperidine	Operation site pain	Kim et al[27]		Buttock
Gentamycin	Elbow sprain	Kim et al[29]		Buttock
Chlorpheniramine maleate	Pruritus	Nischal et al[30]	7 d	Arm
Trabit	Back pain	Ruffieux et al[31]		Buttock
Triamcinolone acetonide	Lichen planus of scalp	Ruffieux et al[31]		Buttock
Salicylate bismuth	Syphilis	Corazza et al[2]	A few days	Buttock, thigh
Ibuprofen	Coxarthrosis	Corazza et al[2]		Buttock
Interferon β		Ozcan et al[5]	3 d	Arm
Benzathine penicillin	Cellulitis	Ruffieux et al[31]		Buttock, L/Ext.
	NS	De Sousa et al[32]	1 d
		Ocak et al[23]
Penicillin G	Fever and cough	Luton et al[12]	2 d	Buttock, L/Ext.
Cyanocobalamin		Luton et al[12]		Buttock
Thiocolchicoside	Back pain	Guarneri et al[7]	2	Buttock
Glatiramer acetate	Multiple sclerosis	Harde et al[22]	2 d	Lower abdomen
		Koller et al[33]
Piroxicam	Ankle sprain	Lee et al[8]		Ankle
DPT	Vaccination	Erkek et al[15]	2 wk	Thigh
DTP-polio-Hib	Vaccination	Bégin et al[14]	2 wk	Thigh
Hydroxyzine	Itching	Gayken et al[16]		Thigh
Calcium hydroxide	Bleeding in the distal root canal	Willbrand et al[34]		Cheek
Lidocaine	Core needle biopsy on breast	García-Vilanova-Comas et al[20]		Breast
Vitamin K	Prematurity	Puvabanditsin et al[18]	2 wk	Thigh
Mesotherapy injections	Tendinopathy	Zaragoza et al[35]	3 wk	Knee

NS: Non-specific; COM: Chronic otitis media; Trabit: Phenylbutazone, salicylamide, dexamethasone and lidocaine; L/Ext: Lower extremity; DPT: Diphtheria-tetanus-pertussis.