Enoxaparin-induced distal haemorrhagic bullous dermatosis

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

“…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. In regard to the topography of the skin lesions, hands were affected in 16 patients, 1,[5][6][7]11,13,14,16,21,24,25,29,31,34 wrists in 1 patient, 24 forearms in 9 patients, 1,5,16,20,29,30,37,38 arms in 8 patients, 6,7,9,10,12,21,23,27 elbows in 1 patient, 20 upper extremities with no other specification in 10 patients, 2,17,18,24,26,28,36 feet in 8 patients, 6,11,12,29,34,35 ankles in 9 patients, 1,3,11,12,…”

“…In one case, the site of the lesion was not specified. 33 On histopathology, the level of the blister showed to be subcorneal in 10 patients, 2,3,8,9,13,17,18,29 intraepidermal in 30 patients, 1,[4][5][6]10,11,16,[21][22][23][24][25][26][27][28][29][30]33,36,37 subepidermal in 8 patients 6,7,14,20,29,35,38 , and both intraepidermal and subepidermal in 1 patient. 29 In 33 cases, there was no significant dermal inflammatory infiltrate.…”

“…29 In 33 cases, there was no significant dermal inflammatory infiltrate. 1,2,7,[9][10][11]13,17,20,[22][23][24][25][26][27][28][29][30]33,[35][36][37][38] Lymphocytic inflammatory infiltrate was present in 10 cases, being mild in 8 patients 6,8,16,18 and moderate in 2 patients. 1,29 Eosinophils were found within the dermal inflammatory infiltrate in 2 cases, 4,29 neutrophils in 2 cases, 5,21 and a mixture of eosinophils and neutrophils in other 2 cases.…”

“…Fifty-nine previously reported cases on HBHD were included. 1–38 We excluded a few cases because work-up was not sufficiently complete, or we could not exclude other differential diagnoses such as bullous pemphigoid or bullous pemphigoid–like drug eruption as the possible cause of bullous hemorrhagic lesions. 39–41 Data of all previous reports included in the study and of our own case were compiled in Table 1.…”

“…The age range was from 21 to 94 years, with an average of 70.8 and a median of 72 years. Nine patients 1,8,9,29,32,37 used UFH, and 54 patients 1–8,10–31,33–38 used low molecular weight heparin (LMWH). Note that 3 patients 8,29,37 used both UFH and LMWH, and other 3 patients 4,6,35 used 2 different types of LMWH.…”