title: Hemorrhagic bullous dermatosis: a rare heparin-induced cutaneous manifestation.
abstract: Heparin is one of the most widely prescribed medications. Cutaneous reactions distant to the injection site are rare and under-reported in the literature. We present an elderly man with history of CNS lymphoma who underwent treatment of a deep venous thrombosis with enoxaparin and subsequently developed well demarcated bullous lesions within days of heparin initiation. The exact pathophysiology is not well understood. Hemorrhagic bullous dermatosis is a rare cutaneous reaction that is temporally associated with the initiation of heparin products. The handful of cases thus far suggest that regression of these seemingly benign lesions may or may not be associated with dose reduction or discontinuation of heparin products and typically occur within a few weeks. Elderly age appears to be one potential risk factor for development of these rare asymptomatic lesions. Malignancy may have some contributing factor and differentiation between this rare cutaneous manifestation from heparin products and other dermatological findings in patients with malignancy is key. Because of the asymptomatic and self-limiting nature of hemorrhagic bullous dermatoses in the setting of heparin product use, we presume that the reported incidence does not reflect true clinical practice.
authors.affiliation: a Department of Neurology , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA.
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Govind
authors.affiliation: b Department of Pathology , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA.
authors.forename: Esteban
authors.initials: E
authors.lastname: Gnass
authors.affiliation: c Department of Vascular Medicine , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA.
authors.forename: Geno
authors.initials: G
authors.lastname: Merli
authors.affiliation: c Department of Vascular Medicine , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Eraso
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D006470:Hemorrhage / Q000139:chemically induced* / Q000473:pathology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Heparin; bullous; enoxaparin; hemorrhagic bullous dermatosis; lesion