Adverse skin reactions to vitamin K₁: report of 2 cases

Abstract

Vitamin K is essential to the biosynthesis of prothrombin and other clotting factors (VII, IX and X), and is mostly used for the prophylaxis of bleeding disorders, mainly in patients with hepatic disfunction (1). 4 different pharmacological forms exist: the natural form K1 (phytomenadione); K2 (menaquinone), which is derived from intestinal bacterial action; K3 (menadione); and K4 (menadiol). The latter 2 are synthetic products. In Italy, only vitamin K1 is marketed (2). Adverse cutaneous reactions to vitamin K are rare; 2 are mainly reported: an erythematous plaque (3, 4) or pseudo‐scleroderma (5) at the injection site. Contact dermatitis and localized urticarial lesions have also been described (2).

Erythema multiforme‐like reaction resulting from vitamin K1 oxide (phytomenadione epoxide)

“…Parenteral vitamin K has been reported to cause delayed hypersensitivity skin reactions, which may be eczematous or morphea‐like, surrounding the puncture sites, or have a diffuse patchy distribution (3–6). Immediate reactions (anaphylaxis) have also been described in relation to either the vitamin itself or the vehicle, namely polyethoxylated castor oil (7, 8).…”

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

“…In most cases, lesions appeared approximately 7-10 d after the first dose of vitamin K 1 [ 17 - 36 ]. In addition, subsequent patch and intradermal testing produce a reaction within 3-5 and 1-2 d, respectively[ 17 - 21 , 23 , 25 , 26 , 31 , 32 , 34 , 36 ]. The time sequence of the development of these reactions corresponded well with type IV cell-mediated hypersensitivity.…”

Recalcitrant Adverse Reaction to Vitamin K: Response to Pulsed Dye Laser

“…Vitamin K 1 is the only commercially available form of vitamin K preparation, which is mainly used for the prophylaxis of bleeding disorders. Adverse cutaneous reactions to vitamin K are quite rare and they are classified into two main categories: 1 sclerodermatous or erythematous plaque‐like reactions. Previous reports state that most erythematous plaque‐like reactions are seen in chronic liver disease patients receiving vitamin K but it is not a necessary condition for this reaction to occur 2 .…”

“…Such cutaneous adverse reactions are classified into two main categories: sclerodermatous or erythematous plaque-like reactions. 1 Most cases present with severe itching sensation and are intractable to routine treatments such as oral, topical, or intralesional corticosteroids. Nevertheless, they spontaneously regress in several months but some may last much longer.…”