Various cutaneous reactions have been associated with heparin use. They include hemorrhage (because of its anticoagulant effect or from heparin-induced thrombocytopenia), skin necrosis and a rare bullous hemorrhagic eruption. Enoxaparin, a low molecular weight heparin derivative, may also cause necrotic lesions. In general, Heparin necrosis (HN) may be associated with heparin-induced thrombocytopenia or systemic thrombosis.
Necrotic lesions may develop 1-17 days after the beginning of heparin use. They most commonly occur at the injection site but may occur elsewhere. Very rarely, life threatening thromboembolic events have been reported. Alternatively, multiple hemorragic vesicles and/or bulla may form.
Discontinuation of the offending agent, wound care and pain control are in order. Avoidance in the future of all heparin products is recommended if possible.
Hemorrhagic vesicles after treatment with enoxaparin. Actas Dermosifiliogr. 2012;103:816-9
Heparin Necrosis at the site of injection. Case Reports Hematology 2013; 2013: 849168.
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