Livedoid dermatitis is a
iatrogenic
Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...
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 location). Intravenous t ...
. It presents as an immediate, extreme pain around the injection site, with overlying skin rapidly becoming
erythematous
Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not assoc ...
, 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 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), vaccines (e.g. Dtap),
corticosteroids, 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.
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
References
{{reflist
Drug eruptions
Vascular-related cutaneous conditions