Embolia Cutis Medicamentosa

An uncommon complication of INTRAMUSCULAR INJECTION leading to variable degrees of necrosis of skin and underlying tissue.

Synonym
Livedo-like Dermatitis
Nicolau Livedoid Dermatitis
Nicolau Syndrome
Nicolau's Livedoid Syndrome
Embolia Cutis Medicamentosa
Nicolau's Syndrome

Excerpt	Reference
"Nicolau syndrome is a rare form of iatrogenic cutaneous necrosis which affects injection sites."	( Bertram, CG; Biswas, A; Mathers, ME; Tabor, D; Williams, AJK, 2018)
"Nicolau syndrome is a skin and underlying tissue necrosis resulting from vascular occlusion after various injections of certain drugs."	( Aktas, H; Ertugrul, G; Terzi, E; Yılmaz, OE, 2020)
"Although Nicolau syndrome is extremely uncommon, physicians must be aware of this complication after intramuscular administration of non-steroidal anti-inflammatory drugs and should avoid unnecessary injections."	( Bianchetti, MG; Faré, PB; Jermini, LMM; Lardelli, PF; Lava, SAG; Milani, GP; Peeters, GGAM; Ramelli, GP; Terrani, I; Vanoni, F; Zgraggen, L, 2020)

Excerpt	Reference
"Nicolau syndrome has been reported with other non-vesicant, injectable medications such as antibiotics and corticosteroids; however, it has not been previously reported with fulvestrant."	( Duco, MR; Murdock, JL; Reeves, DJ; Sharma, SC, 2022)

Excerpt	Reference
"Although Nicolau syndrome is extremely uncommon, physicians must be aware of this complication after intramuscular administration of non-steroidal anti-inflammatory drugs and should avoid unnecessary injections."	( Bianchetti, MG; Faré, PB; Jermini, LMM; Lardelli, PF; Lava, SAG; Milani, GP; Peeters, GGAM; Ramelli, GP; Terrani, I; Vanoni, F; Zgraggen, L, 2020)

Timeframe	Studies, This Condition (%)	All Conditions %
pre-1990	0 (0.00)	23.3326
1990's	0 (0.00)	12.5806
2000's	0 (0.00)	18.1394
2010's	15 (62.50)	28.8240
2020's	9 (37.50)	9.53

Drug	Relationship Strength	Studies
dalteparin	low	1
thiosulfates	low	1
acetaminophen	low	1
amlodipine	low	1
diclofenac	low	7
metoclopramide	low	1
triamcinolone acetonide	low	1
cyclizine	low	1
methylprednisolone hemisuccinate	low	1
sodium thiosulfate	low	1
fulvestrant	low	1
bortezomib	low	1
oxytocin	low	1
mupirocin	low	1
buprenorphine	low	2
vitamin k semiquinone radical	low	1
alprostadil	low	1
naltrexone	low	1
ro13-9904	low	1

Protein Targets (368)

Protein	Potency Measurements	Inhibition Measurements	Activation Measurements	Drugs
RAR-related orphan receptor gamma	4	0	0	4
ATAD5 protein, partial	3	0	0	3
GLS protein	2	0	0	2
Microtubule-associated protein tau	1	0	0	1
Smad3	2	0	0	2
aldehyde dehydrogenase 1 family, member A1	2	0	0	2
thyroid stimulating hormone receptor	1	0	0	1
nuclear receptor subfamily 1, group I, member 3	3	0	0	3
progesterone receptor	4	0	0	4
EWS/FLI fusion protein	2	0	0	2
retinoic acid nuclear receptor alpha variant 1	4	0	0	4
retinoid X nuclear receptor alpha	4	0	0	4
estrogen-related nuclear receptor alpha	5	0	0	5
estrogen nuclear receptor alpha	6	0	0	6
peroxisome proliferator activated receptor gamma	3	0	0	3
aryl hydrocarbon receptor	3	0	0	3
chromobox protein homolog 1	4	0	0	4
thyroid hormone receptor beta isoform 2	4	0	0	4
peripheral myelin protein 22	2	0	0	2
cytochrome P450 3A4 isoform 1	1	0	0	1
Gamma-aminobutyric acid receptor subunit pi	1	0	0	1
ATP-binding cassette sub-family C member 3	0	8	0	8
Multidrug resistance-associated protein 4	0	8	0	9
Solute carrier family 22 member 6	0	1	0	1
Carbonic anhydrase 12	0	2	0	2
UDP-glucuronosyltransferase 1A9	0	1	0	3
Bile salt export pump	0	1	0	1
Voltage-dependent calcium channel gamma-2 subunit	3	0	0	3
Bile salt export pump	0	11	0	11
Cytochrome P450 2B1	0	0	0	1
Cytochrome P450 1A1	0	0	0	1
Carbonic anhydrase 1	0	3	0	3
Carbonic anhydrase 2	0	3	0	3
Myoglobin	0	1	0	1
Cytochrome P450 1A1	0	0	1	2
Cytochrome P450 1A2	0	0	0	1
Prostaglandin G/H synthase 1	0	2	0	2
Carbonic anhydrase 3	0	2	0	2
Cytochrome P450 3A4	0	2	0	2
Cytochrome P450 2D6	0	5	0	6
Cytochrome P450 2C9	0	2	0	3
Polyunsaturated fatty acid lipoxygenase ALOX15	0	1	0	1
Gamma-aminobutyric acid receptor subunit beta-1	1	0	0	1
Sulfotransferase 1A1	0	0	0	1
Gamma-aminobutyric acid receptor subunit delta	1	0	0	1
Gamma-aminobutyric acid receptor subunit gamma-2	1	0	0	1
UDP-glucuronosyltransferase 1-6	0	2	0	3
Glutamate receptor 2	3	0	0	3
Gamma-aminobutyric acid receptor subunit alpha-5	1	0	0	1
Gamma-aminobutyric acid receptor subunit alpha-3	1	0	0	1
Arachidonate 5-lipoxygenase-activating protein	0	1	0	1
UDP-glucuronosyltransferase 1A1	0	2	0	4
Carbonic anhydrase 4	0	2	0	2
Prostaglandin G/H synthase 1	0	2	0	2
Carbonic anhydrase 6	0	2	0	2
Gamma-aminobutyric acid receptor subunit gamma-1	1	0	0	1
Gamma-aminobutyric acid receptor subunit alpha-2	1	0	0	1
Gamma-aminobutyric acid receptor subunit alpha-4	1	0	0	1
Gamma-aminobutyric acid receptor subunit gamma-3	1	0	0	1
Gamma-aminobutyric acid receptor subunit alpha-6	1	0	0	1
Carbonic anhydrase 5A, mitochondrial	0	2	0	2
Prostaglandin G/H synthase 2	0	1	0	2
Carbonic anhydrase 7	0	2	0	2
Nuclear receptor ROR-gamma	1	0	0	1
Cytochrome P450 2J2	0	2	0	2
Gamma-aminobutyric acid receptor subunit alpha-1	1	0	0	1
Gamma-aminobutyric acid receptor subunit beta-3	1	0	0	1
Gamma-aminobutyric acid receptor subunit beta-2	1	0	0	1
Carbonic anhydrase 9	0	3	0	3
GABA theta subunit	1	0	0	1
Canalicular multispecific organic anion transporter 1	0	8	0	8
Carbonic anhydrase 15	0	2	0	2
Carbonic anhydrase 13	0	1	0	1
Gamma-aminobutyric acid receptor subunit epsilon	1	0	0	1
Carbonic anhydrase 14	0	2	0	2
Carbonic anhydrase 5B, mitochondrial	0	2	0	2
toxin B	0	0	0	1
TDP1 protein	6	0	0	6
AR protein	5	0	0	5
glucocorticoid receptor [Homo sapiens]	7	0	0	7
Cellular tumor antigen p53	5	0	0	5
Thromboxane-A synthase	0	1	0	1
Prostaglandin E2 receptor EP3 subtype	0	1	0	1
Prostaglandin E2 receptor EP4 subtype	0	1	1	2
Prostaglandin E2 receptor EP1 subtype	0	1	0	1
Prostacyclin receptor	0	1	1	2
Nuclear receptor subfamily 4 group A member 2	0	0	1	1
Solute carrier organic anion transporter family member 2A1	0	0	0	1
Nuclear receptor subfamily 4 group A member 2	0	0	1	1
Nuclear receptor subfamily 4 group A member 2	0	0	1	1
Prostaglandin E2 receptor EP2 subtype	0	1	1	2
Solute carrier organic anion transporter family member 2A1	0	0	0	1
Solute carrier organic anion transporter family member 2B1	0	1	0	1
Solute carrier organic anion transporter family member 3A1	0	0	0	1
Chain A, Ferritin light chain	2	0	0	2
acid sphingomyelinase	1	0	0	1
cytochrome P450 family 3 subfamily A polypeptide 4	4	0	0	4
G	2	0	0	2
cytochrome P450 2D6	4	0	0	4
IDH1	3	0	0	3
NEDD8-activating enzyme E1 regulatory subunit isoform a	0	1	0	1
NEDD8-conjugating enzyme Ubc12	0	1	0	1
nuclear receptor ROR-gamma isoform 1	3	0	0	3
geminin	4	0	0	4
histone acetyltransferase KAT2A isoform 1	2	0	0	2
Voltage-dependent L-type calcium channel subunit alpha-1C	0	1	0	1
Potassium channel subfamily K member 2	0	1	1	2
Interferon beta	3	0	0	3
HLA class I histocompatibility antigen, B alpha chain	2	0	0	2
ATP-dependent translocase ABCB1	0	1	0	1
Alpha-2A adrenergic receptor	0	6	0	6
Alpha-2C adrenergic receptor	0	2	0	2
Alpha-2B adrenergic receptor	0	2	0	2
Voltage-dependent L-type calcium channel subunit alpha-1C	0	1	0	1
Alpha-2C adrenergic receptor	0	2	0	2
Alpha-2A adrenergic receptor	0	2	0	2
Alpha-1D adrenergic receptor	0	3	0	3
Alpha-1A adrenergic receptor	0	1	0	1
Alpha-1B adrenergic receptor	0	1	0	1
5-hydroxytryptamine receptor 6	0	2	0	2
Spike glycoprotein	2	0	0	2
Sodium-dependent dopamine transporter	0	4	0	4
Voltage-dependent L-type calcium channel subunit alpha-1C	0	1	0	1
Potassium channel subfamily K member 2	0	1	0	1
Inositol hexakisphosphate kinase 1	2	0	0	2
cytochrome P450 2C9, partial	2	0	0	2
Chain H, Proteasome component PUP1	0	1	0	1
Chain I, Proteasome component PUP3	0	1	0	1
Chain K, Proteasome component PRE2	0	1	0	1
Chain L, Proteasome component C5	0	1	0	1
Chain K, Proteasome component PRE2	0	1	0	1
Chain L, Proteasome component C5	0	1	0	1
Proteasome subunit beta type-11	0	1	0	1
Fumarate hydratase	1	0	0	1
PPM1D protein	1	0	0	1
caspase 7, apoptosis-related cysteine protease	1	0	0	1
estrogen receptor 2 (ER beta)	3	0	0	3
farnesoid X nuclear receptor	3	0	0	3
pregnane X nuclear receptor	3	0	0	3
polyprotein	1	0	0	1
peroxisome proliferator-activated receptor delta	4	0	0	4
vitamin D (1,25- dihydroxyvitamin D3) receptor	2	0	0	2
caspase-3	1	0	0	1
cytochrome P450, family 19, subfamily A, polypeptide 1, isoform CRA_a	3	0	0	3
nuclear receptor subfamily 1, group I, member 2	3	0	0	3
Histone H2A.x	1	0	0	1
Caspase-7	1	0	0	1
caspase-3	1	0	0	1
heat shock protein beta-1	4	0	0	4
nuclear factor erythroid 2-related factor 2 isoform 1	4	0	0	4
26S proteasome non-ATPase regulatory subunit 11	0	1	0	1
26S proteasome non-ATPase regulatory subunit 12	0	1	0	1
26S proteasome non-ATPase regulatory subunit 14	0	1	0	1
Proteasome subunit alpha type-7	0	1	0	1
Histone deacetylase 3	0	1	0	1
26S proteasome non-ATPase regulatory subunit 3	0	1	0	1
Prothrombin	0	1	0	1
Chymotrypsinogen A	0	1	0	1
Cathepsin B	0	1	0	1
Neutrophil elastase	0	1	0	1
Cathepsin G	0	2	0	2
Lysosomal protective protein	0	1	0	1
Chymotrypsinogen B	0	1	0	1
26S proteasome regulatory subunit 6A	0	1	0	1
Nuclear factor NF-kappa-B p105 subunit	0	1	0	1
Proteasome subunit beta type-1	0	1	0	2
Chymase	0	1	0	1
Proteasome subunit alpha type-1	0	1	0	1
Proteasome subunit alpha type-2	0	1	0	1
Proteasome subunit alpha type-3	0	1	0	1
Proteasome subunit alpha type-4	0	1	0	1
Proteasome subunit beta type-8	0	1	0	1
Proteasome subunit beta type-8	0	1	0	1
Proteasome subunit beta type-9	0	1	0	1
Proteasome subunit alpha type-5	0	1	0	1
Proteasome subunit beta type-4	0	1	0	1
Proteasome subunit beta type-6	0	1	0	1
Proteasome subunit beta type-5	0	2	0	3
26S proteasome regulatory subunit 7	0	1	0	1
Lon protease homolog, mitochondrial	0	1	0	1
Proteasome subunit beta type-10	0	1	0	1
26S proteasome regulatory subunit 6B	0	1	0	1
26S proteasome non-ATPase regulatory subunit 8	0	1	0	1
Proteasome subunit beta type-3	0	1	0	1
Proteasome subunit beta type-2	0	1	0	2
26S proteasome non-ATPase regulatory subunit 7	0	1	0	1
26S proteasome non-ATPase regulatory subunit 4	0	1	0	1
26S proteasome complex subunit SEM1	0	1	0	1
Proteasome subunit alpha type-6	0	1	0	1
26S proteasome regulatory subunit 4	0	1	0	1
26S proteasome regulatory subunit 8	0	1	0	1
26S proteasome regulatory subunit 10B	0	1	0	1
Beta-carbonic anhydrase 1	0	1	0	1
Nuclear factor NF-kappa-B p100 subunit	0	1	0	1
Transcription factor p65	0	1	0	1
26S proteasome non-ATPase regulatory subunit 2	0	1	0	1
Histone deacetylase 1	0	1	0	1
26S proteasome non-ATPase regulatory subunit 6	0	1	0	1
Proteasomal ubiquitin receptor ADRM1	0	1	0	1
ATP-dependent Clp protease proteolytic subunit	0	1	1	2
Carbonic anhydrase 13	0	1	0	1
NACHT, LRR and PYD domains-containing protein 3	0	1	0	1
Proteasome subunit alpha-type 8	0	1	0	1
Histone deacetylase 2	0	1	0	1
ATPase family AAA domain-containing protein 5	2	0	0	2
Proteasome subunit beta type-7	0	1	0	1
26S proteasome non-ATPase regulatory subunit 1	0	1	0	1
Ataxin-2	2	0	0	2
Histone deacetylase 8	0	1	0	1
Histone deacetylase 6	0	1	0	1
26S proteasome non-ATPase regulatory subunit 13	0	1	0	1
Kappa-type opioid receptor	0	3	0	4
Kappa-type opioid receptor	0	3	1	7
USP1 protein, partial	2	0	0	2
67.9K protein	1	0	0	1
cytochrome P450 2D6 isoform 1	2	0	0	2
Polyunsaturated fatty acid lipoxygenase ALOX15B	1	0	0	1
5-hydroxytryptamine receptor 4	0	4	0	4
Muscarinic acetylcholine receptor M2	0	2	0	2
Muscarinic acetylcholine receptor M4	0	2	0	2
Muscarinic acetylcholine receptor M5	0	2	0	2
Muscarinic acetylcholine receptor M1	0	2	0	2
Muscarinic acetylcholine receptor M3	0	2	0	2
5-hydroxytryptamine receptor 2A	0	4	0	4
5-hydroxytryptamine receptor 2C	0	4	0	4
Histamine H1 receptor	0	2	0	2
D(3) dopamine receptor	0	4	0	4
5-hydroxytryptamine receptor 2B	0	4	0	4
Histamine H2 receptor	1	0	0	1
Aldo-keto reductase family 1 member B10	0	1	0	1
Prostaglandin G/H synthase 1	0	1	0	1
Transient receptor potential cation channel subfamily A member 1	0	0	1	1
Dihydrofolate reductase	0	1	0	1
Cytochrome c oxidase subunit 2	0	1	0	1
Fatty acid-binding protein, liver	0	1	0	1
Transthyretin	0	0	1	3
Albumin	0	1	1	2
Interleukin-8	0	1	0	1
Calcium/calmodulin-dependent protein kinase type II subunit alpha	0	1	0	1
Fatty acid-binding protein, intestinal	0	1	0	1
Aldo-keto reductase family 1 member B1	0	1	0	1
UDP-glucuronosyltransferase 2B7	0	1	0	2
UDP-glucuronosyltransferase 1A4	0	1	0	1
Sodium- and chloride-dependent GABA transporter 1	0	1	0	1
C-X-C chemokine receptor type 1	0	1	0	1
Sodium- and chloride-dependent GABA transporter 2	0	1	0	1
Sodium- and chloride-dependent GABA transporter 3	0	1	0	1
Prostaglandin G/H synthase 2	0	1	0	1
UDP-glucuronosyltransferase 1A3	0	0	0	1
UDP-glucuronosyltransferase 2B10	0	1	0	1
Sodium- and chloride-dependent betaine transporter	0	1	0	1
Prostaglandin G/H synthase 2	0	1	0	1
Prostaglandin G/H synthase 2	0	1	0	1
Solute carrier family 22 member 6	0	1	0	1
Prostaglandin G/H synthase 1	0	1	0	1
Carbonic anhydrase 4	0	1	0	1
Multidrug and toxin extrusion protein 1	0	1	0	1
P2Y purinoceptor 12	0	1	0	1
UDP-glucuronosyltransferase 1A7	0	1	0	1
UDP-glucuronosyltransferase 1A10	0	1	0	1
thioredoxin reductase	2	0	0	2
GALC protein	1	0	0	1
GLI family zinc finger 3	2	0	0	2
arylsulfatase A	1	0	0	1
euchromatic histone-lysine N-methyltransferase 2	4	0	0	4
activating transcription factor 6	1	0	0	1
Nuclear receptor subfamily 1 group I member 2	0	0	1	1
Estrogen receptor	0	2	2	6
Estrogen receptor	0	1	1	2
Progesterone receptor	0	1	0	1
Polyunsaturated fatty acid 5-lipoxygenase	0	1	0	1
Steroid hormone receptor ERR1	0	1	0	1
Bifunctional epoxide hydrolase 2	0	2	0	2
Beta-lactamase TEM	0	1	0	1
Estrogen receptor beta	0	2	0	2
Bile acid receptor	0	1	0	1
NAD-dependent protein deacylase sirtuin-5, mitochondrial	0	1	0	1
Luciferase	2	0	0	2
5-hydroxytryptamine receptor 3E	0	1	1	2
acetylcholinesterase	2	0	0	2
D(1A) dopamine receptor	1	0	0	1
muscarinic acetylcholine receptor M1	1	0	0	1
lamin isoform A-delta10	2	0	0	2
Solute carrier family 22 member 1	0	2	0	2
5-hydroxytryptamine receptor 3B	0	1	1	2
Albumin	0	0	1	1
Myeloperoxidase	0	1	0	1
5-hydroxytryptamine receptor 2C	0	1	0	1
D(2) dopamine receptor	0	2	0	2
5-hydroxytryptamine receptor 2A	0	1	0	1
Alpha-1B adrenergic receptor	0	1	0	1
D	0	1	0	1
D(3) dopamine receptor	0	1	0	1
5-hydroxytryptamine receptor 1A	0	1	0	1
D(2) dopamine receptor	0	1	0	1
Acetylcholinesterase	0	1	0	1
Alpha-1D adrenergic receptor	0	1	0	1
5-hydroxytryptamine receptor 3A	0	1	0	1
D(1B) dopamine receptor	0	1	0	1
5-hydroxytryptamine receptor 1B	0	1	0	1
5-hydroxytryptamine receptor 1D	0	1	0	1
D(4) dopamine receptor	0	1	0	1
5-hydroxytryptamine receptor 1F	0	1	0	1
5-hydroxytryptamine receptor 2B	0	1	0	1
5-hydroxytryptamine receptor 3A	0	2	0	2
Alpha-1A adrenergic receptor	0	1	0	1
5-hydroxytryptamine receptor 3A	0	1	1	2
5-hydroxytryptamine receptor 7	0	1	0	1
6-phosphogluconate dehydrogenase, decarboxylating	0	1	0	1
D(2) dopamine receptor	0	2	0	2
Lactoperoxidase	0	1	0	1
5-hydroxytryptamine receptor 4	0	1	0	2
5-hydroxytryptamine receptor 3D	0	1	1	2
5-hydroxytryptamine receptor 3C	0	1	1	2
5-hydroxytryptamine receptor 3B	0	1	0	1
5-hydroxytryptamine receptor 3B	0	2	0	2
Chain A, Isoleucyl-tRNA synthetase	0	1	0	1
heat shock protein 90	0	0	1	1
streptokinase A precursor	0	0	1	1
twin arginine protein translocation system - TatA protein	0	0	0	1
Isoleucine--tRNA ligase	0	1	0	1
L-cysteine:1D-myo-inositol 2-amino-2-deoxy-alpha-D-glucopyranoside ligase	0	1	0	1
TAR DNA-binding protein 43	2	0	0	2
Estrogen receptor beta	0	0	1	1
Histidine decarboxylase	0	0	1	1
Delta-type opioid receptor	0	2	1	4
Delta-type opioid receptor	0	2	1	3
Kappa-type opioid receptor	0	2	1	3
Mu-type opioid receptor	0	2	1	3
Kappa-type opioid receptor	0	2	1	3
Mu-type opioid receptor	0	2	2	6
Delta-type opioid receptor	0	2	2	6
Nociceptin receptor	0	1	0	1
Mu-type opioid receptor	0	2	1	4
Mu-type opioid receptor	0	2	1	4
UDP-glucuronosyltransferase 1A8	0	0	0	1
Chain A, MAJOR APURINIC/APYRIMIDINIC ENDONUCLEASE	1	0	0	1
Sodium channel protein type 1 subunit alpha	0	1	0	1
Sodium channel protein type 2 subunit alpha	0	1	0	1
Sodium channel protein type 3 subunit alpha	0	1	0	1
Vasopressin V2 receptor	0	1	1	2
Oxytocin receptor	0	2	2	4
Vasopressin V1a receptor	0	1	0	1
Vasopressin V1a receptor	0	2	1	3
Vasopressin V1b receptor	0	1	1	2
Vasopressin V1b receptor	0	1	0	1
Oxytocin receptor	0	1	0	1
Oxytocin receptor	0	0	1	1
Vasopressin V2 receptor	0	1	0	1
Potassium voltage-gated channel subfamily H member 2	0	1	0	1
hypoxia-inducible factor 1 alpha subunit	2	0	0	2
thyroid stimulating hormone receptor	1	0	0	1
nuclear factor of kappa light polypeptide gene enhancer in B-cells 1 (p105), isoform CRA_a	2	0	0	2
v-jun sarcoma virus 17 oncogene homolog (avian)	1	0	0	1
Chain A, Beta-lactamase	2	0	0	2
SMAD family member 2	1	0	0	1
SMAD family member 3	1	0	0	1
hypoxia-inducible factor 1, alpha subunit (basic helix-loop-helix transcription factor)	1	0	0	1
nuclear factor erythroid 2-related factor 2 isoform 2	1	0	0	1
Glucocorticoid receptor	0	2	0	2
Glycine receptor subunit alpha-1	0	2	0	2
Glycine receptor subunit beta	0	2	0	2
Glycine receptor subunit alpha-2	0	2	0	2
Glycine receptor subunit alpha-3	0	2	0	2
thioredoxin glutathione reductase	1	0	0	1
vitamin D3 receptor isoform VDRA	1	0	0	1
DNA polymerase iota isoform a (long)	1	0	0	1
Rap guanine nucleotide exchange factor 3	1	0	0	1
[prepared from compound, protein, and bioassay information from National Library of Medicine (NLM), extracted Dec-2023]

Embolia Cutis Medicamentosa

Synonyms(6)

Research Excerpts

Overview

Context

Treatment

Research

Studies (24)

Protein Targets (368)

Embolia Cutis Medicamentosa

Synonyms(6)

Research Excerpts

Overview

Context

Treatment

Research

Studies (24)

Drugs Studied (24)

Protein Targets (368)