Nikolau Syndrome: Necrotic Activity of Drugs and Ways to Prevent Post-Injection Abscesses (In memory of Professor László A Gömze)

Post-injection abscess, which is the sad finale of Nicolau syndrome, continues to attract the attention of researchers due to the need to clarify the causes of this iatrogenic disease in order to develop effective measures for its prevention. For many years, researchers from all over the world have tried from different perspectives to explain the mechanism of the drugs effect that causes post-injection pain syndrome, infiltration, inflammation, erimatous skin damage, necrosis and abscess (Nicolau syndrome), but to no avail. This has been done only in recent years. There are findings in Russia that show that drugs considered to be of high quality today, in some cases, in addition to specific pharmacological activity, may have necrotic activity of a non-specific nature of action. The findings showed that according to the established pharmaceutical practice and in full compliance with the pharmacopoeia requirements for the quality of medicines, pharmaceutical products produced by different pharmaceutical companies, as well as those included in different series of the same pharmaceutical company, may have different compositions (formulations), contain different ingredients, therefore they may have different physico-chemical properties. In this regard, drugs of different serial numbers and/or different manufacturers, which are considered high-quality today, can be hypertonic solutions, have acidifying or alkalizing activity, have alcohols, aldehydes and heavy metal salts in denaturing concentrations. This is the reason that in some cases drugs have necrotic (cauterizing) activity. In this regard, to prevent Nicolau syndrome, it is proposed to reduce the physico-chemical aggressiveness of drugs. Today, this can be done successfully by diluting them with water for injection 2 to 8 times before injection.