Diclofenac abuse

Abstract

A woman in her 40's developed skin ulcers and major depressive disorders following diclofenac abuse for headache. The 42-year-old woman presented with a history of relapsing ulcer on lower extremity since 2 years. The ulcer were noted on site of diclofenac [diclofenac sodium] administration, which she injected herself (skin popping) for headache and when in an anger. Dermatological evaluation showed several ulcerations of 1-2cm size, hyperpigmentation, multiple atrophic, deep and devastating scars on thighs and lower extremity and depressed scars on bilateral extensor surfaces of femoral skin. Histological examination revealed dermo-epidermal junction separation, thrombus in vascular lumen and dense inflammatory infiltration in dermis. MRI of the affected area revealed sole involvement of skin. During psychiatric evaluation, she was diagnosed to have major depressive disorder. Thus, following investigations, eventually, she was diagnosed with diclofenac abuse-related psychiatric disorders and major depressive disorder.For major depressive disorder,the woman was treated with cognitive behavioral therapy and venlafaxine. Additionally, she received triticum [triticum vulgare], fusidic acid, aminophenyl ether and ethylene glycol for skin ulcer [outcomes not stated].