Abstract
Medications are a rare and often ignored cause of limb ulcers. It is presumed that around 1.1% of chronic leg ulcers can be caused by drugs. Limb ulcers can be related to the pharmacological action of drugs or can be the manifestation of drug induced vasculitis or immunological alterations. Early suspicion of drug involvement in the induction of ulcers can result in timely intervention and can prevent considerable morbidity and mortality. Cutaneous ulcers can be observed in complicated cases of drug related immunological conditions such as Stevens-Johnson syndrome (SJS). The aim of the present chapter is to provide a comprehensive review on common drugs implicated in limb ulcers, the possible mechanisms of ulcer development, the phenotypic patterns of drug induced extremity ulcers, their management, and outcomes.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Körber A, Klode J, Al-Benna S, Wax C, Schadendorf D, Steinstraesser L, et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Dtsch Dermatol Ges. 2011;9(2):116–21.
Dissemond J. Medications A rare cause for leg ulcers. Der Hautarzt. 2011;62(7):516–23.
Sirieix M-E, Debure C, Baudot N, Dubertret L, Roux M-E, Morel P, et al. Leg ulcers and hydroxyurea. Arch Dermatol. 1999;135(7):818.
Duron D, Blaise S, Cracowski J-L, Roustit M, Khouri C. Drug-induced skin ulcers: A disproportionality analysis from the WHO pharmacovigilance database. J Am Acad Dermatol. 2021;85(1):229–32.
Ammad Ud Din M, Hussain SA, Jamshed S. Leg ulcer with long-term hydroxyurea use. Clin Case Rep. 2021;9(4):2487–8.
Bryant JR, Andrade P, Hajjar RT, Lumley CR, Chaiyasate K. Malleolar ulceration induced by hydroxyurea therapy for chronic eosinophila. J Am Coll Clin Wound Spec. 2016;8(1–3):47–50.
Best PJ, Daoud MS, Pittelkow MR, Petitt RM. Hydroxyurea-induced leg ulceration in 14 patients. Ann Intern Med. 1998;128(1):29–32.
de França ER, Teixeira MAG, de Matias KF, Antunes DECM, de Braz RA, CEF S. Efeitos colaterais cutâneos após uso prolongado de hidroxiuréia na Policitemia Vera. An Bras Dermatol. 2011;86(4):751–4.
Rappoport L, Körber A, Grabbe S, Dissemond J. Auftreten von Ulcera crurum in Zusammenhang mit der Einnahme von Anagrelid. Dtsch Med Wochenschr. 2007 Feb;132(7):319–21.
Oskay T, Özen M. Anagrelide associated with leg ulcers in a case of essential thrombocythaemia. Turk J Hematol. 2021.
Chan YC, Valenti D, Mansfield AO, Stansby G. Warfarin induced skin necrosis. Br J Surg. 2002;87(3):266–72.
Stewart AJ, Penman ID, Cook MK, Ludlam CA. Warfarin-induced skin necrosis. Postgrad Med J. 1999;75(882):233–5.
Kakagia DD, Papanas N, Karadimas E, Polychronidis A. Warfarin-induced skin necrosis. Ann Dermatol. 2014;26(1):96.
Handschin AE, Trentz O, Kock HJ, Wanner GA. Low molecular weight heparin-induced skin necrosis—a systematic review. Langenbeck's Arch Surg. 2005;390(3):249–54.
Warkentin TE. Clinical picture of heparin-induced thrombocytopenia (HIT) and its differentiation from non-HIT thrombocytopenia. Thromb Haemost. 2016;116(11):813–22.
Arepally GM, Padmanabhan A. Heparin-induced thrombocytopenia. Arterioscl Throm Vas Biol. 2020.
Garcia GD, Goff JM, Hadro NC, O’Donnell SD, Greatorex PS. Chronic ergot toxicity: a rare cause of lower extremity ischemia. J Vasc Surg. 2000;31(6):1245–7.
Glazer G, Myers KA, Davies ER. Ergot poisoning. Postgrad Med J. 1966;42(491):562–8.
Merhoff CC, Porter JM. Ergot intoxication. Ann Surg. 1974;180(5):773–9.
Lawrence CM, Dahl MGC. Two patterns of skin ulceration induced by methotrexate in patients with psoriasis. J Am Acad Dermatol. 1984;11(6):1059–65.
Kurian A, Haber R. Methotrexate-induced cutaneous ulcers in a nonpsoriatic patient: case report and review of the literature. J Cutan Med Surg. 2011;15(5):275–9.
Tekur V. Methotrexate-induced nonhealing cutaneous ulcers in a nonpsoriatic patient without pancytopenia. Indian Dermatol Online J. 2016;7(5):418.
Hocaoglu N, Atilla R, Onen F, Tuncok Y. Early-onset pancytopenia and skin ulcer following low-dose methotrexate therapy. Hum Exp Toxicol. 2008;27(7):585–9.
McCoy CM. Leflunomide-associated skin ulceration. Ann Pharmacother. 2002;36(6):1009–11.
Jakob A, Porstmann R, Rompel R. Skin ulceration after leflunomide treatment in two patients with rheumatoid arthritis. JDDG. 2006;4(4):324–7.
Lindquist LA, Feinglass J, Martin GJ. How sedative medication in older people affects patient risk factors for developing pressure ulcers. J Wound Care. 2003;12(7):272–5.
Prasad HRY, Khaitan BK, Ramam M, Sharma VK, Pandhi RK, Agarwal S, et al. Diagnostic clinical features of pentazocine-induced ulcers. Int J Dermatol. 2005;44(11):910–5.
Sahu KK, Sawatkar GU, Sahu SA, Mishra AK, Lal A. Pentazocine-induced skin ulcers. Am J Med Sci. 2020;359(3):182–3.
Wall AE, Weaver SM, Litt JS, Rae L. Propylthiouracil-associated Leukocytoclastic necrotizing cutaneous Vasculitis. J Burn Care Res. 2017;38(3):e678–85.
Seo JW, Son HH, Choi JH, Lee SK. A case of p-ANCA-positive Propylthiouracil-induced pyoderma Gangrenosum. Ann Dermatol. 2010;22(1):48.
Levin LE, Magro C, Horowitz J, Harp J. Hydralazine-associated cutaneous vasculitis presenting with aerodigestive tract involvement. Cutis. 2017;99(5):E25–9.
Kumar B, Strouse J, Swee M, Lenert P, Suneja M. Hydralazine-associated vasculitis: overlapping features of drug-induced lupus and vasculitis. Semin Arthritis Rheum. 2018;48(2):283–7.
Agdamag AC, Gevorgyan O, Lawrenz Co M, Hassan S. Multiple cutaneous and mucosal lesions in a patient with cocaine-levamisole–induced vasculopathy syndrome. Proc (Bay Univ Med Cent). 2019;32(1):93–5.
Mikeljevic J, Highet AS. Nicorandil-induced leg ulceration without mucosal involvement. Clin Exp Dermatol. 2011;36(4):372–3.
Babic V, Petitpain N, Guy C, Trechot P, Bursztejn AC, Faillie JL, et al. Nicorandil-induced ulcerations: a 10-year observational study of all cases spontaneously reported to the French pharmacovigilance network. Int Wound J. 2018;15(4):508–18.
Warthan MM, Jumper CA, Smith JL. Acneiform eruption induced by Iressa (gefitinib) tablets used to treat non-small cell lung cancer. J Drugs Dermatol. 2004;3(5):569–70.
Lipworth AD, Robert C, Zhu AX. Hand-foot syndrome (hand-foot skin reaction, palmar-plantar erythrodysesthesia): focus on sorafenib and sunitinib. Oncology. 2009;77(5):257–71.
Sathyanarayanan V, Lokesh KN, Channaviriappa LK, Jacob LA. Gefitinib-induced skin ulceration in metastatic adenocarcinoma lung. Indian J Med Paediatr Oncol. 2014;35(1):109–10.
Roger A, Sigal M-L, Bagan P, Sin C, Bilan P, Dakhil B, et al. Ulcères des membres inférieurs développés sous inhibiteurs de tyrosine kinase (sunitinib, nilotinib). Ann Dermatol Venereol. 2017;144(1):49–54.
Kuntz T, Koushk-Jalali B, Kreuter A. Sunitinib-induced pyoderma gangrenosum-like skin ulcer. Can Med Assoc J. 2020;192(20):E552–2.
Gibson A, Gardner J, O’Donnell J. Erythropoietin and painful leg ulcers: thrombosis or vasculitis? Arthritis Rheum. 2005;53(5):792–2.
Luca S, Romeo S. Edema and skin ulcers of the lower limbs as a collateral effect of nifedipine. A clinical case report. Minerva Cardioangiol. 1999;47(6):219–22.
Carmichael AJ, Paul CJ. Vasculitic leg ulcers associated with diltiazem. BMJ. 1988;297(6647):562–2.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Kaur, U. (2023). Drug Induced Ulceration of Extremities. In: Khanna, A.K., Tiwary, S.K. (eds) Uncommon Ulcers of the Extremities. Springer, Singapore. https://doi.org/10.1007/978-981-99-1782-2_17
Download citation
DOI: https://doi.org/10.1007/978-981-99-1782-2_17
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-99-1781-5
Online ISBN: 978-981-99-1782-2
eBook Packages: MedicineMedicine (R0)