Clinical characteristics and treatment of terlipressin‐induced ischemic skin necrosis: A synthesis of 35 literature reported cases

• Published in: Journal of clinical pharmacy and therapeutics Vol. 47; no. 8; pp. 1270 - 1275
• Main Authors: Zhou, Yulu, Zeng, Jiang, Song, Liying, Wang, Chunjiang
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.08.2022
• Subjects: Biopsy; Case reports; Fibrin; hepatorenal syndrome; Ischemia; ischemic complications; Necrosis; Patients; Purpura; Scrotum; Skin; skin necrosis; terlipressin; Thrombosis; ischemic complications; skin necrosis; terlipressin; hepatorenal syndrome; ischemia
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.13671

What is known and objective The clinical features of terlipressin‐induced ischemic skin necrosis are unknown. The purpose of this study is to explore the clinical features of terlipressin‐induced skin necrosis. Methods We searched Chinese and English databases to collect case reports of terlipressin‐induced skin necrosis for retrospective analysis. Results and discussion A total of 42 patients (31 males and 11 females) from 35 studies were included, with a median age of 54 years (range 0.17–84). The onset of skin ischemia ranged from a few hours to 21 days. The most common clinical manifestations were bulla (15 cases, 35.7%), cyanosis (12 cases, 28.6%), necrosis (11 cases, 26.2%), and purpura (10 cases, 23.8%). The following were often affected: the legs (26 cases), 61.9%), abdomen (13, 31.0%), scrotum (10 cases, 23.8%), feet (10 cases, 23.8%), upper extremities (8 cases, 19.0%), and hands (7 cases, 16.7%). Skin biopsy showed fibrin thrombus (7 cases, 38.9%), nonspecific inflammation (6 cases, 33.3%), and necrosis (10 cases, 55.6%). After discontinuation of terlipressin, skin symptoms improved in most patients. What is new and conclusion Ischemic skin necrosis is a rare and serious adverse effect of terlipressin. Patients receiving terlipressin therapy should be monitored closely for terlipressin‐related ischemic complications. Terlipressin should be discontinued immediately if ischemic complications occur. We collected published case reports of terlipressin‐induced ischemic skin necrosis by searching Chinese and English databases to explore the clinical features, treatment strategies, and prognosis of terlipressin‐induced ischemic skin necrosis.