Bullous dermatosis at distant sites in patients treated with heparin

Castellanos-González, María; Velasco-Rodríguez, Diego; Plaza, Ana Belén Mancebo

doi:10.1016/j.medcle.2016.06.024

Cited by 4 publications

(11 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A delayed-type hypersensitivity reaction has been proposed, requiring prior sensitisation to heparin. 3 One systematic review reported that among patients with a primary sensitisation to unfractionated heparin, as suspected in our patient, the overall risk of cross-reaction to other heparins was 72.2%. 4 Discontinuation of treatment may not be necessary as the lesions are often self-limiting despite continued use of heparin, typically resolving within weeks without complications.…”

mentioning

confidence: 57%

“…2 Clonal eosinophilia might occur in other World Health Organization defined myeloid malignancies, including chronic myelogenous leukaemia, myelodysplastic syndromes, chronic myelomonocytic leukaemia and systemic mastocytosis. 3 In the present case, hypereosinophilic syndrome and eosinophilic leukaemia were excluded due to the detection of Philadelphia chromosome abnormality, a marker of CML. End-organ damage may occur in eoCML.…”

Section: Mucocutaneous Manifestations In a Case Of Eosinophilic Variamentioning

confidence: 89%

See 1 more Smart Citation

Enoxaparin‐induced bullous haemorrhagic dermatosis

et al. 2019

View full text Add to dashboard Cite

mentioning

confidence: 57%

Section: Mucocutaneous Manifestations In a Case Of Eosinophilic Variamentioning

confidence: 89%

Enoxaparin‐induced bullous haemorrhagic dermatosis

et al. 2019

View full text Add to dashboard Cite

“…[39][40][41] Data of all previous reports included in the study and of our own case were compiled in Table 1. HBHD affected 44 men [1][2][3][4][5][6][7][8][9][10][11]13,17,19,21,23,24,[26][27][28][29][30][31][32][33][34]36 and 16 women, 1,2,6,12,14,22,25,29,35,36 with a male/female rate of 2.75. The age range was from 21 to 94 years, with an average of 70.8 and a median of 72 years.…”

Section: Resultsmentioning

confidence: 99%

“…3,14 In 11 cases, data about histopathologic features were not available. 5,7,12,15,19,22,31,32,34,36 Direct immunofluorescence was performed in 18 cases, all of them with negative results. 1,2,4,[6][7][8]10,16,23,28,36,37 In regard to the intervention related to heparin treatment, in 34 cases, heparin was discontinued [1][2][3][4][6][7][8][9]11,12,15,16,18,22,24,[26][27][28][29][30][31][32][33][34]36,37 ; in 1 case, the dose was reduced 21 ; in 1 cas...…”

Section: Resultsmentioning

confidence: 99%

“…1,2,4,[6][7][8]10,16,23,28,36,37 In regard to the intervention related to heparin treatment, in 34 cases, heparin was discontinued [1][2][3][4][6][7][8][9]11,12,15,16,18,22,24,[26][27][28][29][30][31][32][33][34]36,37 ; in 1 case, the dose was reduced 21 ; in 1 case, UFH was changed to dalteparin 29 ; and in 19 cases, heparin treatment was continued. 1,5,6,10,13,14,17,19,[23][24][25]35,…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Heparin-Induced Bullous Hemorrhagic Dermatosis: A Report of an Exceptionally Exuberant Case and Literature Review

Almeida

Campos

Daxbacher

et al. 2021

The American Journal of Dermatopathology

View full text Add to dashboard Cite

Introduction: Heparin-induced bullous hemorrhagic dermatosis (HBHD) is an unusual cutaneous adverse reaction to heparin characterized by acute onset of hemorrhagic bullae.Methodology: An exuberant case of HBHD is reported, and a revision of previously reported cases indexed on PubMed is provided. Cases were tabulated to the following parameters: sex, age, type of heparin and route of administration, associated medical procedure, number of days between heparin start and onset of lesions, site of the lesions, level of blister on histopathology, inflammatory infiltrate on histopathology, direct immunofluorescence findings, heparin-related intervention, number of days to resolution of skin lesions, associated hemorrhagic event, and outcome.Case report: A 21-year-old woman with end-stage renal disease was receiving intravenous unfractioned heparin (UFH) during hemodialysis section for the past 3 months. Four hours after using for the first time an arteriovenous fistula punctured on her right wrist, the patient noticed the onset of vesicles and blisters on the right forearm containing citrus or serohemorrhagic exudate, which became overt hemorrhagic in 24 hours. Histopathology depicted a nonacantholytic subcorneal blister containing erythrocytes and plasma without any significant dermal inflammatory infiltrate.Results: Sixty cases of HBHD were included. HBHD affected predominantly men, with a male/female rate of 2.75. The age range was from 21 to 94 years, with an average of 70.8 and a median of 72 years. Nine patients used UFH, and 54 patients used low molecular weight heparins (3 patients used both). The lapse of time between the start of heparin and the onset of skin lesion varied from 6 hours to 240 days, with an average of 17.3 days and a median of 7 days. Limbs were affected in most of the cases. The level of the blister was subcorneal in 10 patients, intraepidermal in 30, subepidermal in 8, and both intraepidermal and subepidermal in 1. In 33 cases, there was no significant dermal inflammatory infiltrate. Pure lymphocytic inflammatory infiltrate was present in 10 cases. Eosinophils were found within the dermal inflammatory infiltrate in 2 cases, neutro-phils in 2, and a mixture of eosinophils and neutrophils in other 2. Direct immunofluorescence was performed in 18 cases, all of them with negative results.Discussion: We hypothesize that mechanical trauma, skin fragility, and the anticoagulation effect of heparin might contribute concomitantly to the development of the lesions and speculate that subepidermal blisters in HBHD could be formed by rupture of the floor of a former intraepidermal blister.

show abstract

Clinical Features, Diagnosis, Treatment, and Prognosis of Heparin-Induced Bullous Hemorrhagic Dermatosis

Li,

Peng,

Zhang

et al. 2024

Dermatologic Therapy

View full text Add to dashboard Cite

Background. Heparin-induced bullous hemorrhagic dermatosis (HBHD) is a rare cutaneous adverse effect of heparin and has unclear clinical features. We explored the clinical features of HBHD to provide evidence for the safe use of heparin. Methods. We collected HBHD-related case reports for a retrospective analysis by searching the Chinese and English databases from inception to December 31, 2022. Results. Seventy-two patients, including 51 males (70.8%), were included, and they had a median age of 71.5 years (range: 21, 94). Low-molecular-weight heparin was used in 62 patients (86.1%), and unfractionated heparin was used in 10 patients (13.9%). The median time for HBHD to appear was 7 days (range: 0.25, 270). Lesions appeared far from the injection site, and the extremities (57 patients, 79.2%) were the most frequently involved site. The blisters were mainly located in the intraepidermal (34 patients, 47.2%), subcorneal (10 patients, 13.9%), and subepidermal (9 patients, 12.5%) regions. Thirty-seven patients (51.4%) had no obvious dermal inflammatory infiltration, and 20 patients (27.8%) had lymphocytic inflammatory infiltration. Sixty-seven patients (93.1%) recovered from their skin lesions after the discontinuation of heparin or despite continuing heparin and at a median treatment time of 14 days (range: 2, 141). Conclusion. HBHD is a rare self-limiting disease that occurs far from the injection site. Clinicians should be aware of BHD during the administration of heparin. Heparin can be discontinued or continued depending on the patient’s condition.

show abstract

Bullous dermatosis at distant sites in patients treated with heparin

Cited by 4 publications

References 33 publications

Enoxaparin‐induced bullous haemorrhagic dermatosis

Enoxaparin‐induced bullous haemorrhagic dermatosis

Heparin-Induced Bullous Hemorrhagic Dermatosis: A Report of an Exceptionally Exuberant Case and Literature Review

Clinical Features, Diagnosis, Treatment, and Prognosis of Heparin-Induced Bullous Hemorrhagic Dermatosis

Contact Info

Product

Resources

About