Coumadin-Induced Skin Necrosis

Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN


Wounds. 2002;14(6) 

In This Article

Differential Diagnosis

Differential diagnosis is a challenge, as CISN may mimic multiple other conditions. Most affected patients have had a serious medical event and suffer from multiple chronic illnesses. CISN must be distinguished from purpura fulminans, necrotizing fasciitis, microembolization, pressure ulcers, breast cancer, calciphylaxis, pyoderma gangrenosum, venous gangrene, purple toe syndrome, heparin-induced skin necrosis, and cryofibrinogenemia.[12]

Differential diagnosis of CISN is complicated by the frequent occurrence of subcutaneous hemorrhage in patients on oral anticoagulants. Hemorrhagic complications, however, are not common early in the course of therapy and do not result in skin or tissue necrosis.[21]

Clinical history and cutaneous distribution may be of major assistance in distinguishing CISN from other conditions, because CISN lesions are difficult to distinguish histologically by biopsy. Biopsy results suggestive of CISN usually show fibrin and thrombi in small dermal vessels with no evidence of inflammatory infiltration.[13,21]


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