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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives: To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods: A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions: Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety. [ABSTRACT FROM AUTHOR]

Background: Cyanoacrylate adhesive closure is a technically simple alternative to endothermal ablation of peripheral veins. N-butyl cyanoacrylate is delivered via catheters or by percutaneous injection resulting in occlusion of target veins. The local tissue reaction or the systemic immune response that may follow have not been characterised. Aim: To characterise the late local tissue reaction to N-butyl cyanoacrylate glue injected in peripheral vessels. Methods: Biopsies were obtained from two patients. In patient one, distal tributaries of the great saphenous vein were injected with VenaBlock™ glue under ultrasound guidance. Ultrasound-guided incisional biopsies were performed at one week, six weeks and 12 months. In patient two, a peripheral arterio-venous malformation was injected with Venablock™ and biopsy was performed 12 months later. Histological analysis was performed using haematoxylin and eosin and immunofixation with CD-4, CD-31, CD-34, CD-68 and D2-40. Results: Echogenic material with a strong shadow artefact consistent with the injected N-butyl cyanoacrylate was observed on ultrasound on all follow-up occasions. Biopsies taken at one week showed intravascular glue without histiocytes. Biopsies at six weeks showed isolated foreign body histiocytes coating intravascular fibrillary glue spicules but no granuloma formation. The one-year biopsies showed extravascular changes including fibrosis, lymphoid aggregates and multiple extravascular foreign body cavitated granulomas. Some vessel lumens contained residual spicules of glue but no intravascular granulomas. The extravascular granulomas were deeply located, asymptomatic and not complicated by clinical ulceration. Histologically, there was no evidence of transepidermal elimination. Conclusion: Extravascular foreign body cavitated granulomas containing spicules of glue with fibrosis and lymphoid aggregates occur as a delayed finding following the use of N-butyl cyanoacrylate. [ABSTRACT FROM AUTHOR]

The Expert Panel for Cosmetic Ingredient Safety reviewed newly available studies since their original assessment in 2005, along with updated information regarding product types and concentrations of use, and confirmed that these 22 methacrylate ester monomers are safe as used in nail enhancement products in the practices of use and concentration as described in this report, when skin contact is avoided. [ABSTRACT FROM AUTHOR]

The Expert Panel for Cosmetic Ingredient Safety (Panel) reviewed the safety of Polyaminopropyl Biguanide (polyhexamethylene biguanide hydrochloride), which functions as a preservative in cosmetic products. The Panel reviewed relevant data relating to the safety of this ingredient and concluded that Polyaminopropyl Biguanide is safe in cosmetics in the present practices of use and concentration described in the safety assessment, when formulated to be nonirritating and nonsensitizing, which may be based on a quantitative risk assessment or other accepted methodologies. The Panel also concluded that the data are insufficient to determine the safety of Polyaminopropyl Biguanide in products that may be incidentally inhaled. [ABSTRACT FROM AUTHOR]