Nazarian Rosalynn M, Van Cott Elizabeth M, Zembowicz Artur, Duncan Lyn M
Department of Pathology and Dermatopathology Unit, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Am Acad Dermatol. 2009 Aug;61(2):325-32. doi: 10.1016/j.jaad.2008.12.039.
Warfarin-induced skin necrosis is a rare complication of anticoagulant therapy with a high associated morbidity and mortality requiring immediate drug cessation. Cutaneous findings include petechiae that progress to ecchymoses and hemorrhagic bullae. Characteristic dermatopathological findings are diffuse dermal microthrombi with endothelial cell damage and red cell extravasation with progression to full-thickness coagulative necrosis. The lesions of warfarin-induced skin necrosis may be difficult to differentiate from mimickers, but skin biopsy in conjunction with careful consideration of the clinical history, including time of onset, cutaneous distribution of the lesions, and laboratory findings, are essential for prompt diagnosis and patient treatment. Herein, we review the clinical and histologic features helpful for differentiating warfarin-induced skin necrosis and report a case illustrative of the diagnostic difficulty that may at times be encountered in clinical practice.
华法林诱导的皮肤坏死是抗凝治疗的一种罕见并发症，具有较高的发病率和死亡率，需要立即停药。皮肤表现包括瘀点，可发展为瘀斑和出血性大疱。特征性的皮肤病理表现为弥漫性真皮微血栓形成，伴有内皮细胞损伤和红细胞外渗，进而发展为全层凝固性坏死。华法林诱导的皮肤坏死病变可能难以与相似病症相鉴别，但结合仔细考虑临床病史（包括发病时间、病变的皮肤分布和实验室检查结果）进行皮肤活检，对于及时诊断和患者治疗至关重要。在此，我们回顾有助于鉴别华法林诱导的皮肤坏死的临床和组织学特征，并报告一例说明临床实践中有时可能遇到的诊断困难的病例。
