Nicolau syndrome due to hyaluronic acid injections

Abstract

Six cases of vascular compromise after hyaluronic injection are reported. Clinical symptoms realized a Nicolau syndrome, which is characterized by immediate pain, livedoid pattern and a few days later by the appearance of scabs and skin necrosis. This type of complication is rare, but may be dramatic and injectors must be aware of that. A thorough knowledge of facial anatomy is mandatory to avoid the risky facial areas. The use of a flexible cannula instead of a sharp needle has much less risk of hurting vessels and must be preferred. The support of the patient is discussed and a treatment protocol is proposed.

Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents

“…Andre and Haneke [17] published 4 cases of facial necrosis due to intravascular injection in the angular artery as well as by compression of the facial artery when filling the nasolabial groove. According to this author, all cases were resolved without sequelae or vascular effects.…”

“…Andre and Haneke [17] described the appearance of a livedoid pattern by intravascular injection in the upper labial artery in a 30-year-old woman a few minutes after filling the upper lip vermilion with hyaluronic acid. The skin was massaged, and she was given oral treatment with aspirin (500 mg) twice daily.…”

“…Andre and Haneke [17] refer to the development of a livedoid pattern on the right side of the nose, cheek, and forehead after the injection of hyaluronic acid into the tip of the nose.…”

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

“…Nicolau syndrome has been reported after injection of many other drugs such as non-steroidal antiinflammatory drugs (3,4), benzathine penicillin (5), buprenorphine (6), bortezomib (7), hyaluronic acid (8), oxytocin (9), glatiramer acetate (10), glucocorticoid (11), vitamin K (12), pneumococcal conjugate vaccine (13) and other vaccines (14). It may be seen following intramuscular (3-5, 9, 12), subcutaneous (7,10,14) intraarticular (11), intraarterial, intravenous, failed extravascular injections (6), intradermal mesotherapy (15) and sclerotherapy (16) applications.…”

The Use of Hyaluronidase to Treat the Excess of Cross-Linked Hyaluronic Acid Following Aesthetic Medicine Procedures: A Practical Point of View

“…Patients' examples in the present article were treated with Desinfiltral a hyaluronidase sold by skin tech pharma group as described by other physicians [1][2][3][4].…”