Clinical Features, Diagnosis, Treatment, and Prognosis of Heparin-Induced Bullous Hemorrhagic Dermatosis

Abstract

Background. Heparin-induced bullous hemorrhagic dermatosis (HBHD) is a rare cutaneous adverse effect of heparin and has unclear clinical features. We explored the clinical features of HBHD to provide evidence for the safe use of heparin. Methods. We collected HBHD-related case reports for a retrospective analysis by searching the Chinese and English databases from inception to December 31, 2022. Results. Seventy-two patients, including 51 males (70.8%), were included, and they had a median age of 71.5 years (range: 21, 94). Low-molecular-weight heparin was used in 62 patients (86.1%), and unfractionated heparin was used in 10 patients (13.9%). The median time for HBHD to appear was 7 days (range: 0.25, 270). Lesions appeared far from the injection site, and the extremities (57 patients, 79.2%) were the most frequently involved site. The blisters were mainly located in the intraepidermal (34 patients, 47.2%), subcorneal (10 patients, 13.9%), and subepidermal (9 patients, 12.5%) regions. Thirty-seven patients (51.4%) had no obvious dermal inflammatory infiltration, and 20 patients (27.8%) had lymphocytic inflammatory infiltration. Sixty-seven patients (93.1%) recovered from their skin lesions after the discontinuation of heparin or despite continuing heparin and at a median treatment time of 14 days (range: 2, 141). Conclusion. HBHD is a rare self-limiting disease that occurs far from the injection site. Clinicians should be aware of BHD during the administration of heparin. Heparin can be discontinued or continued depending on the patient’s condition.