[Nicolau livedoid dermatitis after sclerotherapy of varicose veins]

The accidental intra arterial injection of a sclerosing drug is a rare but well known accident, which can cause ischemia of the limb. The aspect of Nicolau livedoid dermatitis is less acknowledged. The ignorance of this entity or the confusion between the latter and an extravasation of the injected drug can delay an urgent treatment.

A 39 year-old woman went to outpatients consultation, after sclerotherapy of a varicose vein of the right popliteal area, for the occurrence of a purpuric, painful plaque of the right popliteal area and the right calf. In spite of the late institution of a treatment including a potent vasodilator (iloprost) and an anticoagulant (calcic nadroparin), the patient recovered without important after effects.

Nicolau livedoid dermatitis during sclerotherapy of a varicose vein has rarely been described before. Our case emphasizes the fact that these apparently superficial injections might involve this complication. Using an echo-Doppler device for targeting the varicose vein did not prevent the accident. Successive punctures on one site before injection might favor this event. Prevention relies on guidelines for the injection technique. Respecting these guidelines reduces the risk of complication without completely preventing it.