Skin necrosis

Warfarin Bleeding, skin necrosis Clinical signs of bleeding3 baseline CBC and platelet count CBC and platelet count every 6 months following hospital discharge baseline aPTT and INR daily INR until two consecutive INRs are within the target range then once weekly x 2 weeks, then every month... 

History of warfarin-induced skin necrosis Inability to obtain follow-up PT/INR measurements Inappropriate medication use or lifestyle behaviors... 

Bullfrog, Rana catesbeiana-, larvae sublethal concentration 10 Skin necrosis in 96 h 9... 

Nonhemorrhagic adverse effects include the rare purple toe syndrome and skin necrosis. 

Absolute contraindications to warfarin include active bleeding, hemorrhagic tendencies, pregnancy, and a history of warfarin-induced skin necrosis. It should be used with great caution in patients with a history of GI bleeding, recent neurosurgery, alcoholic liver disease, severe renal... 

Skin Necrosis Observation At Termination A = None B = Slight C = Moderate D = Marked E = Severe... 

Application of 0.01 mL chloroform for 24 hours to the skin of rabbits caused only slight irritation (Smyth et al. 1962). Skin necrosis was observed in rabbits dermally exposed to 1,000 mg/kg chloroform for 24 hours (Torkelson et al. 1976). These LOAEL values are recorded in Table 2-3. 

Protein C concentrate (Human) Purpura fuhninans and coumarin-induced skin necrosis in patients with severe congenital protein C deficiency... 

Skin - Severe, occasionally fatal dermatologic reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis, skin necrosis, and erythema multiforme, have been reported within days of methotrexate administration. 

Dermal/Ocular Effects. Skin necrosis was evident at the site of application in rabbits after exposure of the skin to dose levels of 388 mg/kg hexachlorobutadiene for 8 hours (Duprat and Gradiski 1978). However, most skin lesions had healed within 2 weeks. 

Dermal/Ocular Effects. No studies were located regarding dermal/ocular effects in humans. Acute-duration dermal exposure caused skin necrosis in rabbits however, effects were reversible within 2 weeks (Duprat and Gradiski 1978). Nasal irritation resulted from 15 minute exposure to vapor concentrations of 155 ppm (de Ceaurriz et al. 1988). No dermal/ocular effects were seen following intermediate- or chronic-duration dermal exposure in rabbits. Based on acute effects in rabbits, hexachlorobutadiene may pose some risk to humans following skin contact with the chemical-depending on the area exposed. Inhalation of vapors may cause irritation of the nasal mucosa. 

Pentazocine (Talwin) (see also page 252) Street Names Crackers, poor man s h oin, T s and R s> Ts and Rits (all refer to combinations w/ Ritalin) (brands Talwin, Talwin Nx [CIV]) Use Medically used as opioid analgesic euphoria similar to heroin when mixed w/antihistamines combined w/ methylphenidate (Ritalin) is new abuse combination Actions Agonist-antagonist narcotic naloxone, a narcotic antagonist added to Talwin (Talwin NX) has reduced incidence of abuse Effects Euphoria, hallucinations, skin necrosis w/ illicit injection route... 

Coumarin-induced skin necrosis is a rare complication of oral anticoagulant therapy. Especially patients suffering from a rare and life-threatening blood disorder known as protein C deficiency are at risk. In these cases Protein C Concentrate (human). 

The principal adverse reaction to warfarin is hemorrhage. Prolonged therapy with the coumarin-type anticoagulants is relatively free of untoward effects. Bleeding may be observable (e.g., skin, mucous membranes) or occult (e.g., gastrointestinal, renal, cerebral, hepatic, uterine, or pulmonary). Rarer untoward effects include diarrhea, small intestine necrosis, urticaria, alopecia, skin necrosis, purple toes, and dermatitis. 

Injecfion sife reacfion, such as inflammafion, oozing, nodules, and skin necrosis Rare (less than 2%)... 

F. Place in therapy Avonex has shown significant advantages over interferon beta-lb (Betaseron) in the treatment of multiple sclerosis. It is administered once a week rather than every other day, and it is not associated with the high incidence of injection site skin necrosis reported with interferon beta-lb in some studies. It appears (based on indirect comparison) at... 

To demonstrate the ability of HDI to be a direct irritant to the skin, HDI was applied to the non-oeeluded intaet skin of adult male albino guinea pigs either undiluted (100%) or in solutions of 0.05, 0.5, 5, or 25% in 1 1 aeetone-dioxane eontaining 13% guinea pig fat. HDI was demonstrated to produce severe-eiythema and edema when applied to the skin at concentrations of 5, 25, and 100%. Applieation of undiluted material resulted in frank skin necrosis. Moderate irritation to intaet skin was noted at the 0.5% HDI dose, while a 0.05% solution failed to produce any perceptible eutaneous irritation response (Haskell Laboratory 1961). 

Dermal Effects. Dermal effects of HDI are limited to those cases of topical exposure. HDI has been demonstrated to be a topical irritant in several studies in laboratory animals at topical (non-occluded) doses as low as 0.1%, resulting in erythema, edema, and, in some cases, frank skin necrosis (Haskell Laboratory 1961). Studies that dosed HDI on the skin of rabbits, with the dosing site occluded, resulted in more severe cutaneous reactions (Mobay Corporation 1981a). In addition to its local irritation effect,... 

When used in high doses for long periods to treat life-threatening conditions, e.g. SIRS, it may result in peripheral ischaemia or even gangrene. Extravascular leakage my result in skin necrosis. If used in late pregnancy it may induce uterine contractions and/or reduce placental blood flow. 

Morbidity and mortality in HIT are related to thrombotic events. Venous thrombosis occurs most commonly, but occlusion of peripheral or central arteries is not infrequent. If an indwelling catheter is present, the risk of thrombosis is increased in that extremity. Skin necrosis has been described, particularly in individuals treated with warfarin in the absence of a direct thrombin inhibitor, presumably due to acute depletion of the vitamin -dependent anticoagulant protein C occurring in the presence of high levels of procoagulant proteins and an active hypercoagulable state. 

Intestinal and peripheral vasoconstriction can follow prolonged infusion, resulting in gangrene of intestinal segments or of skin, fingers, or limbs. This has been fatal in several cases, and vasopressin should be withdrawn if skin necrosis occurs (SEDA-13,1310 7). 

Skin necrosis is often reported after vasopressin therapy. In a retrospective study, two of five patients treated with a continuous infusion of terlipressin developed skin necrosis at the infusion site and a third developed scrotal necrosis (15). 

A 46-year-old woman with septic shock had a peripheral venous infusion of vasopressin 0.04 U/minute in addition to dobutamine, via the subclavian vein extravasation of vasopressin to local soft tissue resulted in ischemic skin necrosis (26). 

Purpuric skin necrosis, due to local vasoconstriction, has been reported in 19 patients within a few days of starting vasopressin infusion (27). 

Bullous necrosis developed within 48 hours of starting an infusion of terlipressin in a 44-year-old man (28). There have been only four previous reports of skin necrosis. 

Kahn JM, Kress JP, Hall JB. Skin necrosis after extravasation of low-dose vasopressin administered for septic shock. Crit Care Med 2002 30(8) 1899-901. 

Contraindications include hypotension, peripheral ischemia, confusion, thrombophlebitis, skin necrosis from extravasation, bradycardia, second and third degree heart block, cardiogenic shock, overt heart failure, and bronchos pasm. 

Information regarding the excretion of chromium in humans after dermal exposure to chromium or its compounds is limited. Fourteen days after application of a salve containing potassium chromate(VI), which resulted in skin necrosis and sloughing at the application site, chromium was found at 8 mg/L in the urine and 0.61 mg/100 g in the feces of one individual (Brieger 1920). A slight increase (over background levels) in urinary chromium levels was observed in four subjects submersed in a tub of chlorinated water containing 22 mg chromium(VI)/L as potassium dichromate(VI) for 3 hours (Corbett et al. 1997). For three of the four subjects, the increase in urinary chromium excretion was less than 1 pg/day over the 5-day collection period. 

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