Multiple subcutaneous haematomas of the legs causing skin necrosis in an elderly patient affected by corticosteroid‐induced skin atrophy: Case report and review of literature

• Published in: International wound journal Vol. 17; no. 3; pp. 540 - 546
• Main Authors: Vallini, Valerio, Rinaldi, Elisabetta, Mangano, Luciana, Modesti, Luca, Ghelardini, Piero, Roberts, Anna Theresa, Grazi, Giovanni
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-06-2020
• Subjects: Adrenal Cortex Hormones - adverse effects; Aged, 80 and over; Anticoagulants - adverse effects; Atrophy; compartment syndrome; corticosteroid‐induced skin atrophy; Female; Hematoma - diagnosis; Hematoma - etiology; Hematoma - surgery; Humans; Leg; Necrosis; Negative-Pressure Wound Therapy; Original; porcine xenograft; Skin - pathology; skin necrosis; Skin Transplantation; skin necrosis; compartment syndrome; corticosteroid-induced skin atrophy; porcine xenograft
• ISSN: 1742-4801; 1742-481X
• DOI: 10.1111/iwj.13312

Corticosteroid‐induced skin atrophy (CISA) consists of a thinning of the skin and subcutaneous tissues, representing the natural consequence of a prolonged glucocorticosteroids use, both systemic as well as topical. It is characterised by the loss of elasticity and skin thickness, associated with an increased skin fragility leading to ecchymoses, haematomas, and steroid purpura. The management of CISA is a challenge for physicians, as the pathology is reversible in a minimal percentage of cases and only after a short topical steroid or low‐dose course therapy. Often wounds with large loss of substance represent the more common complication, after a surgical drainage which is often necessary. Skin necrosis with compartment syndrome of a leg is another potential risk for these patients. Here, we report a case of an elderly patient affected by multiple subcutaneous haematomas of the legs causing skin necrosis, arisen after the use of anticoagulants for a deep venous thrombosis. The patient was successfully treated with surgical drainage, negative pressure wound therapy (NPWT), and porcine xenograft with no complications. Finally, we discuss the evidence of the current literature on topic.