Nonsteroidal anti-inflammatory drugs and necrotising fasciitis. An update

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and others are the treatment of choice for mild to moderate pain. Because of the relative safety and efficacy of NSAIDs, many of the agents are now available in the US and in other parts of the world without a physician prescription. While these drugs are relatively well tolerated, adverse effects resulting from their use can occur. One such adverse effect recently linked to NSAID use is necrotising fasciitis. Reports of necrotising fasciitis possibly associated with NSAID use have been published in both the medical and lay literature. Several hypotheses regarding a possible association between NSAIDs and the development of necrotising fasciitis have appeared in the literature. One hypothesis is a simple masking of the signs and symptoms of an existing infection, leading to a delay in diagnosis. Some authors have speculated that in certain skin and soft-tissue infections, particularly those caused by group A beta-haemolytic streptococci, this delay in diagnosis may have allowed a simple infection to progress to necrotising fasciitis. Other postulated mechanisms of NSAID involvement in the development of necrotising fasciitis include an impairment of natural host defense mechanisms. A review of the medical literature for reports of possible NSAID-associated necrotising fasciitis revealed that the events were rare, but clinically significant. From the available evidence, a causal relationship between NSAIDs and necrotising fasciitis cannot be established.