Pseudoscleroderma secondary to phytomenadione (vitamin K1) injections: Texier's disease

Environmental Risks for Systemic Sclerosis

There is an increasing body of literature suggesting a relationship between environmental factors and the development of systemic sclerosis (SSc). These include occupational exposures, chemical materials, medications, alterations in the microbiome, and dysbiosis. Environmental exposures may impact epigenetic regulation thereby triggering an aberrant immune response resulting in the clinical and serologic phenotype that we diagnose as SSc. Screening and studying putative triggers will not only improve our understanding of the pathogenesis of SSc but also inform the institution for protective measures.

Cutaneous allergic reaction to subcutaneous vitamin K1: A case report and review of literature

BACKGROUND

Vitamin K1 (phytomenadione) is a fat-soluble naturally occurring vitamin that is widely used to treat certain coagulation disorders. Adverse cutaneous reactions to vitamin K1 can occur; however, owing to its low incidence and considerable variability in presentation and morphology, its diagnosis can be easily overlooked. Managing these reactions may be challenging for patients and clinicians. Therefore, reviewing the adverse cutaneous reactions to vitamin K1 is important.

CASE SUMMARY

Here we report the case of a 50-year-old woman with no pre-existing hepatic disease who developed a cutaneous allergic reaction to subcutaneous vitamin K1 that presented as localized eczematous plaques at the vitamin K1 injection site. The eruption developed within 5 d of the injection and persisted for 32 mo despite treatment with topical and intralesional steroids. Eczema was diagnosed based on the results of the pathological examination, immunohistochemical staining, and a skin biopsy. The patient was advised to take herbal medicines orally twice daily. After treatment and follow-up, the patient's eczematous urticarial plaques improved and her condition stabilized.

CONCLUSION

Here we present the first case of a cutaneous allergic reaction to subcutaneous vitamin K1 that was successfully treated with Chinese medicine.

Erythema in local and trunk skin caused by intramuscular injection of vitamin K1: A case report and literature review

A 52-year-old woman presented with erythema, papules, pain, and itching on the buttocks and trunk that had persisted for 1 week. Twenty-two days before admission, the patient received three intramuscular injections of vitamin K1 in the gluteal muscles. Two weeks after the last intramuscular injection edematous hard erythema developed bilaterally on the gluteal muscles, accompanied by itching, pain, and a burning sensation. Afterward, the erythema and papules gradually spread to the trunk, with notable itching. Dermatological examination revealed a large area of well-defined edematous hard erythema, and blisters around the injection sites on both hips. The skin temperature was high, with mild tenderness. Dense distributions of edematous erythema and papules were observed on the trunk, some of which were fused into pieces. The patient received a diagnosis of a skin reaction induced by intramuscular injections of vitamin K1. Therefore, she was administered glycyrrhizin, calcium, vitamin C, antihistamines, topical polysulfonic mucopolysaccharide cream, and glucocorticoid cream, and the lesions subsided after 2 weeks.

Ulcerative versus non-ulcerative panniculitis: is it time for a novel clinical approach to panniculitis?

Panniculitis, or inflammation of the fatty tissue, is an ongoing diagnostic challenge to both dermatologists and pathologists. The basis of the current panniculitis classification is histology, whether the inflammation is mainly located in the fibrovascular septa or in the adipose lobules thereafter with or without vasculitis. However, overall, the difficulty rises due to various terminologies and lack of clinical relevance with this classification. In addition to that, the majority of panniculitides have mixed infiltration of both lobular and septal and not a clear-cut distinction. The aim of this article is to provide a novel clinical algorithm to the diagnosis of panniculitis and thus to provide guidelines for all clinicians who may encounter this challenging condition in their clinical practice.

Toward Understanding of Environmental Risk Factors in Systemic Sclerosis [Formula: see text]

IMPORTANCE

Systemic sclerosis (SSc) is a severe, chronic, and incurable autoimmune fibrotic skin disease with significant extracutaneous involvement. Low concordance rate in twin studies and unequal geographic distribution of SSc argues for importance of environment in disease initiation and progression.

OBJECTIVE

In this manuscript we provide a summary of all investigated potential external risk factors for SSc.

DATA SOURCES

A literature search in PubMed and EMBASE database was performed for studies published until January 1, 2020 by 2 reviewers (EN and LO) independently.

FINDINGS

Occupational and/or environmental exposures to silica and organic solvents are associated with increased incidence and severity of SSc. Exposure to epoxy resins, asbestos, and particulate air pollution favors increased risk of SSc, but data are based on limited number of observational studies. There is insufficient evidence to conclude an association between SSc development and other occupational (eg, welding fumes) or personal exposures (eg, smoking, vitamin D deficiency). Association of SSc with silicone breast implants has been disproven. Infectious pathogens (eg, Helicobacter pylori and angiotropic viruses) and dysbiosis seem to play a role in SSc development and severity, but their role remains to be clarified.

CONCLUSIONS AND RELEVANCE

It may be prudent to counsel our patients with SSc (or those at risk of SSc) to avoid occupations with exposure to silica, organic solvents, asbestos and epoxy resins; restraint from smoking, using cocaine or drugs with pro-fibrotic potential. While the association between low vitamin D and SSc remains to be confirmed, we believe that SSc patients should be encouraged to maintain healthy vitamin D levels as benefits outweigh the risks.

A Study about the Cause and Clinicopathologic Findings of Injection-Induced Dermatitis

Background

Objective

Methods

Results

Conclusion

Vitamin B12-Associated Localized Scleroderma and Its Treatment

BACKGROUND

Localized drug-induced injection site reactions are rare. Injection site sclerodermoid reactions have been reported as a result of multiple drugs, most commonly vitamin K. Sclerodermoid injection site reactions have also been reported with pentazocine, progestin, and vitamin B12. Little has been written on the efficacious treatment of this complication.

OBJECTIVE

The objective was to raise awareness of the potential complication of localized sclerodermoid change secondary to vitamin B12 injections and to present a novel approach to its treatment.

METHODS

We report a case and review the English literature for injection site reactions from vitamin B12 as well as treatment options for this complication.

RESULTS

We report the first non-European case of localized sclerodermoid reaction secondary to vitamin B12 injections. Our patient presented with disfiguring depression of the left upper arm following vitamin B12 injections for macrocytic anemia secondary to Crohn's disease. Histopathology showed findings similar to those seen in localized scleroderma. The patient was successfully treated with excision of diseased skin, local fat transfer, and complex repair with dramatic improvement at 5 months in contour and overall appearance.

Cutaneous allergic reaction to intramuscular vitamin K1

A 40-year-old woman with no pre-existing hepatic disease developed a cutaneous allergic reaction to intramuscular vitamin K1. She received this medication prophylactically prior to surgery, developed severe localized, and subsequently generalized, dermatitis, beginning 5 days after administration of the Konakion Cremophor-EL form of vitamin K1 by intramuscular injection at four sites on her thighs. Investigation by patch and intradermal testing revealed delayed-type hypersensitivity to Konakion Cremophor-EL, Konakion Mixed Micelles and pure vitamin K1, but not Cremophor-EL vehicle alone. This case is unusual because the patient was also shown to be patch test positive to vitamin K3 sodium bisulfite.