Warfarin Induced Skin Necrosis: A Diagnostic Challenge

Abstract

Warfarin is a commonly used oral anticoagulant in the treatment of many major chronic illnesses. Early diagnosis and discontinuation of warfarin are crucial for the better prognosis. We are sharing an interesting case of warfarin-induced skin necrosis to increase physician awareness as warfarin induced skin necrosis is difficult to differentiate from some other dermatologic conditions. This case also illustrates that a high degree of suspicion combined with clinical history, laboratory findings and sometimes skin biopsy are required to make diagnosis.

Warfarin-induced skin necrosis in a patient with protein S deficiency

“…The initial lesion is a well-defined, painful erythematous macule that progresses to ecchymosis and then to necrotic tissue. 5 The diagnosis is clinical, and histopathology can be helpful in confirming the diagnosis. 3 …”

“…Even though it is not usually a life-threatening condition, the inability of early recognition and treatment can lead to sequelae that impair the patients’ quality of life. 5 …”