Multiple subcutaneous haematomas of the legs causing skin necrosis in an elderly patient affected by corticosteroid‐induced skin atrophy: Case report and review of literature

Abstract

Corticosteroid‐induced skin atrophy (CISA) consists of a thinning of the skin and subcutaneous tissues, representing the natural consequence of a prolonged glucocorticosteroids use, both systemic as well as topical. It is characterised by the loss of elasticity and skin thickness, associated with an increased skin fragility leading to ecchymoses, haematomas, and steroid purpura. The management of CISA is a challenge for physicians, as the pathology is reversible in a minimal percentage of cases and only after a short topical steroid or low‐dose course therapy. Often wounds with large loss of substance represent the more common complication, after a surgical drainage which is often necessary. Skin necrosis with compartment syndrome of a leg is another potential risk for these patients. Here, we report a case of an elderly patient affected by multiple subcutaneous haematomas of the legs causing skin necrosis, arisen after the use of anticoagulants for a deep venous thrombosis. The patient was successfully treated with surgical drainage, negative pressure wound therapy (NPWT), and porcine xenograft with no complications. Finally, we discuss the evidence of the current literature on topic.

A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients?

“…Chronic administration of corticosteroids impairs the immune response, and the patient was affected by a marked corticosteroid-induced skin atrophy, a condition that is associated with loss of elasticity, reduced skin thickness, and increased fragility involving both the skin and the capillaries, leading to ecchymoses, hematomas, and new wound onset. 24-26…”

“…Chronic administration of corticosteroids impairs the immune response, and the patient was affected by a marked corticosteroid-induced skin atrophy, a condition that is associated with loss of elasticity, reduced skin thickness, and increased fragility involving both the skin and the capillaries, leading to ecchymoses, hematomas, and new wound onset. [24][25][26] Second, multiple injections may have acted as a trigger for inflammation. This phenomenon, known as "pathergy," is common for some neutrophilic dermatoses such as pyoderma gangrenosum (PG) 27 and sweet syndrome, 28 which are auto-inflammatory conditions often associated with other systemic diseases.…”