NICOLAU SYNDROME DUE TO INTRAMUSCULAR DICLOFENAC SODIUM INJECTION

Nicolau syndrome (NS) is a rare complication characterized by tissue necrosis that occurs after parenteral injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery, acute vasospasm and cytotoxic effects of the drug. Severe pain in the immediate post injection period and purplish discoloration of the skin with reticulate pigmentary pattern is characteristic of this syndrome. Diagnosis is mainly clinical and there is no standard treatment for the disease. Herein, we present a rare case of NS due to Diclofenac Sodium (Voltaren®) injection in an 80-year-old female suffering from Lower Respiratory Tract Infection (LRTI) who was managed conservatively. Keywords: Nicolau Syndrome, Embolia cutis medicamentosa, Voltaren, Diclofenac sodium

Case Report: Nicolau syndrome due to etofenamate injection

Nicolau syndrome, also known as embolia cutis medicomentosa, is a rare complication characterized by tissue necrosis that occurs after injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery and cytotoxic effects of the drug. Severe pain in the immediate postinjection period and purplish discoloration of the skin with reticulate pigmentary pattern is characteristic of this syndrome. Diagnosis is mainly clinical and there is no standard treatment for the disease. Etofenamate is a non-steroidal anti-inflammatory drug and a non-selective cyclooxygenase inhibitor. Cutaneous adverse findings caused by etofenamate are uncommon. Herein, we present a case with diagnosis of Nicolau syndrome due to etofenamate injection, which is a rare occurrence.

Dermoscopic Characteristics of Melasma in Indians: A Cross-sectional Study

ABSTRACT Introduction The aim of this study was to assess the various dermoscopic features of melasma in Indian population. Materials and methods A total of 100 cases of clinically diagnosed melasma and 50 controls without melasma or any other facial pigmentation were studied dermoscopically at a tertiary care center in Eastern India. The various described relevant patterns of pigmentation on dermoscopy were recorded. Similar patterns were also looked for in the control population and the two compared. Statistical analysis was done with Fisher's exact test and a p-value of <0.05 was considered statistically significant. Results Cases consisted of 75 females and 25 males with an average age of 36 years as against an average age of 35 years for controls. Of the various patterns of pigmentation, reticuloglobular pigmentation was statistically significant in association with melasma (p < 0.0001). The unpatterned patchy brown black pigment was also significantly associated with melasma as compared to controls (p - 0.0346). A granular pigmentary pattern was also shown to be significantly associated with a diagnosis of melasma (p - 0.0123). Telangiectasia was seen more frequently in patients as compared to controls (p - 0.0327). Perifollicular brown black globules were not significantly correlated with a diagnosis of melasma. More than one pattern was present in a number of patients. Conclusion Dermoscopy of melasma can be used for diagnosis, prognosis, and response or adverse effect of therapy. Study limitations Lack of direct correlation with histopathology and inclusion of therapy naïve as well as patients on therapy were major limitations of this study. How to cite this article Neema S, Chatterjee M. Dermoscopic Characteristics of Melasma in Indians: A Cross-sectional Study. Int J Dermoscop 2017;1(1):6-10.

MESODERM-ECTODERM INTERACTION IN THE PRODUCTION OF THE AGOUTI PIGMENTATION PATTERN IN MICE

ABSTRACT Alleles at the agouti locus in the mouse determine the synthesis of either phaeomelanin or eumelanin by follicular melanocytes by altering the hair follicle environment. The method of dermal-epidermal recombination of mouse skin from C57BL/6J a/a and C57BL/6J Aw-J/Aw-J embryos was used in this study to establish the precise site of agouti gene action within the hair follicle. The pigmentary pattern of hairs formed in the recombination skin grafts was specific for the genotype of the dermal (mesodermal) component of the hair follicle. The genotype of the epidermal (ectodermal) component had no influence on the type of hair pigmentary pattern. These results indicate that future studies on gene mechanisms should focus on the dermis as the determining factor in altering the hair follicle environment.

Properties of the Minerals in the Exuvia of Crustacea

An unusual reaction between material in the exuviae of Crustacea and pure cold mercuric chloride, resulting in the deposition of a bright red compound, led to the discovery that, contrary to expectation, the inner surface of the fresh moult, and even of the inter-moult exoskeleton, is strongly alkaline (pH = 9.1). This is near the optimum for both alkaline phosphatase and carbonic anhydratase, which both may be active in resorption of mineral preparatory to ecdysis. Correlations between the distributions of the red Hg-compound, phosphate, carbonate, alkaline phosphatase, and pigmentary pattern have been found in various Crustacea. The reaction with cold HgCl2 is given also by the millipede exoskeleton, the molluscan shell, the calciferous gland-material of earthworms (pH 9.2-9.4) and by calcareous sponges, but not by echinoderm or vertebrate skeletons, and not by the exoskeleton of insects, spiders, and centipedes, which lack mineral. The compound(s) with mercuric chloride are probably chiefly oxychlorides. A steady, if slight, solution of the skeletal carbonate and phosphate is necessary to maintain the observed high pH, and to permit the formation of these mercury-compounds.