Does early hyperbaric oxygen therapy prevent extremity necrosis in Nicolau syndrome?

Reconstruction of gluteal defects related to Nicolau Syndrome secondary to intramuscular injection of diclofenac sodium with negative pressure wound therapy followed by skin graft.

“…'s case report of a pediatrics patient claims that hyperbaric oxygen therapy with vasoactive agents started within the 24 hours of the Nicolau syndrome diagnosis can prevent the development of necrosis and tissue loss (20).…”

Nicolau syndrome after benzathine penicillin treated with hyperbaric oxygen therapy

“…[1][2][3] Nicolau syndrome can be associated with transitory or permanent ischemia of the ipsilateral limb, compartment syndrome, acute renal failure, rectal hemorrhage, and neurologic complications such as paraplegia, hypoesthesia, and sphincter deficits. 1,[4][5][6] The diagnosis is based on the clinical presentation, 2 and there are no other positive criteria. The appearance of a livedoid eruption soon after an IM or intra-articular drug administration and the exclusion of other causes, such as necrotizing fasciitis, allowed us to establish the diagnosis.…”

“…3,7,8 Conservative treatment includes the administration of analgesics, vasoactive agents such as heparin and pentoxifylline, anticoagulants, systemic steroids, and eventually antibiotics. 2,5,9 Additional treatments comprise surgical debridement, skin grafting, and reconstruction with skin, fasciocutaneous, or musculocutaneous flaps. 3,8 The greatest benefit of HBOT is achieved in compromised nutritive flow and oxygen supply to tissues caused by local injury or infection.…”

“…10 The rationale for its use is Figure 1 Clinical presentation of Nicolau syndrome in a 19-year-old woman, after the 3rd IM benzathine benzylpenicillin injections for tonsillitis that intermittent hyperoxia may stimulate the healing process through collagen synthesis and by enabling angiogenesis, increase erythrocyte deformability, and reduce edema and reperfusion injury. 5,10 Given the vascular pathogenesis of Nicolau syndrome, 1,3,8 HBOT should be considered as an important complementary treatment, if it can be instituted soon after the event. 5,7 However, further studies are needed to assess its efficacy in Nicolau syndrome.…”

“…5,10 Given the vascular pathogenesis of Nicolau syndrome, 1,3,8 HBOT should be considered as an important complementary treatment, if it can be instituted soon after the event. 5,7 However, further studies are needed to assess its efficacy in Nicolau syndrome. Kindler syndrome (KS) is a rare autosomal recessive skin disorder characterized by skin blistering, photosensitivity, skin atrophy, progressive poikiloderma, chronic inflammation, and mucosal stenosis.…”