Enoxaparin-induced hemorrhagic bullous dermatosis in a leprosy patient

Abstract

Enoxaparin is a low-molecular-weight heparin that has been used widely to prevent and treat thromboembolic disorders for at least 30 years. The most common adverse skin reactions to enoxaparin are ecchymosis and skin necrosis due to vasculitis, urticaria, angioedema and erythema. Side effects from heparin administration are rare and usually located at the injection site. However, recent reports have suggested that they can also occur at a distance from the site of injection. Moreover, the etiopathogenesis has not been fully explained. In this article, we present a case of hemorrhagic bullous dermatosis associated with enoxaparin for the treatment of ischemic heart disease that developed in a patient with a past history of lepromatous leprosy.

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

“…[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.…”

“…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.…”

Heparin induced bullous hemorrhagic dermatosis at a site distant from the injection. A report of five cases

“…1,2 First reported at 2006 by Perrinaud et al, bullous hemorrhagic dermatosis is a rare cutaneous reaction to heparin in which hemorrhagic intraepidermal bullae appear in areas distant from the heparin injection sites and of which there are less than 20 cases described in the literature. 1,2 …”

“…More recent reports indicate that in most cases discontinuation of the treatment is not necessary. 2,4 In the cases in which we decided to maintain treatment the lesions eventually disappeared. However, in one case the lesions where persistent for a month and a half hence treatment was changed with complete resolution afterwards.…”