Warfarin induced skin necrosis

Background: Warfarin induced skin necrosis is a rare complication with a pr evalence of 0.01-0.1 per cent. It was first described in 1943, Methods: A literature review was undertaken using Medline; all relevant pap ers on this rare complication of warfarin therapy were used. Results: There are several adverse skin manifestations associated with the use of oral anticoagulants, ranging from ecchymoses and purpura, haemorrhag ic necrosis, maculopapular vesicular urticarial eruptions to purple toes. T his article concentrates mainly on warfarin induced skin necrosis, The synd rome typically occurs during the first few days of warfarin therapy, often in association with the administration of a large initial loading dose of t he drug. Although the precise nature of the disease is still unknown, advan ces in knowledge about protein C, protein S and antithrombin III anticoagul ant pathways have led to a better understanding of the mechanisms involved in pathogenesis, Differential diagnosis between warfarin induced skin necro sis and necrotizing fasciitis, venous gangrene and other causes of skin nec rosis may be difficult; the disease may also be confused with other dermato logical entities. Conclusion: Warfarin induced skin necrosis, while rare, is an important com plication. All surgeons should be aware of its existence.