Cutaneous hypersensitivity reactions to vitamin K: 2 case reports and a review of the literature

Abstract

Between 1964 and 1994, at least 52 patients with cutaneous adverse effects of vitamin K have been described in the European and North American literature. A review of the details of these patients is given and 2 new cases reported. Adverse effects are seen not only in patients with liver-function disturbances but also in patients without liver diseases, and occur mostly after intramuscular or subcutaneous administration of vitamin K1, independent of the total dose. Patch and intracutaneous tests often give positive reactions. The mechanism of action is probably in many patients a delayed-type hypersensitivity reaction.

Cutaneous allergic reaction to intramuscular vitamin K1

“…Of these adverse events, 48 related to skin disorders that occurred at the ‘application site’, that is the site of injection. A similar number of cases ( n = 52) of application‐site reactions to vitamin K1, have been documented in the European and North American literature 16 . Two types of reaction have been described:…”

Contact dermatitis due to topical cosmetic use of vitamin K

“…The lipid‐soluble vitamin K (phytomenadione) causes more cutaneous reations than its water‐soluble analogues (2). In previous reports, cutaneous hypersensitivity reactions to injection of vitamin K were seen in patients with liver disease, suggesting a relationship (1). There are also reported cases of cutaneous reactions to vitamin K 1 after its intramuscular injection in patients who have it for hypothrombinemia without liver disease (1, 3).…”

“…In previous reports, cutaneous hypersensitivity reactions to injection of vitamin K were seen in patients with liver disease, suggesting a relationship (1). There are also reported cases of cutaneous reactions to vitamin K 1 after its intramuscular injection in patients who have it for hypothrombinemia without liver disease (1, 3). Reactions to water soluble vitamin K are less common, because vitamin K is absorbed through the skin (2).…”

“…Vitamin K exists in 4 different forms: vitamin K 1 (phytomenadione), the natural form; vitamin K 2 (menaquinone) from intestinal bacterial synthesis; and vitamin K 3 (menadione) and K 4 (menadiol) as synthetic analogues (1). The lipid‐soluble vitamin K (phytomenadione) causes more cutaneous reations than its water‐soluble analogues (2).…”

Adverse skin reactions to vitamin K1: report of 2 cases

“…However, since then, patients with no signs of liver disease have been described: therefore, the high prevalence of adverse reactions in patients with hepatic disease probably depends on the large number of hepatopathic patients needing treatment with vitamin K (2). To the best of our knowledge, no cases have been described in which orally administered vitamin K resulted in adverse reactions: only parenteral oil-soluble vitamin K seems to be able to react (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”