Anticoagulant-Induced Skin Necrosis

  • Rare reaction typically seen 2–5 days after offending drug started; typically due to warfarin or heparin; likely related to drop in protein C level
  • Present with painful erythematous plaque that turn into necrotic ulcers and or bullae due to ischemic infarcts; typically seen on buttocks, thighs, or breasts
  • Treatment: stop offending drug, vitamin K, IV concentrate of protein C