Severe adverse cutaneous reactions to drugs

To the Editor: In their excellent review of cutaneous reactions to drugs (Nov. 10 issue), Roujeau and Stern1 include vasculitis associated with lymphomas in the differential diagnosis of drug-induced vasculitis. Cutaneous vasculitis has also been associated, although infrequently, with solid tumors.2,3 Among hematologic cancers, leukemias have been associated with cutaneous vasculitis more often than lymphomas have.2 The dermatologic manifestations may antedate the discovery of the neoplasia, and pathologically, the most common manifestation is a leukocytoclastic vasculitis. To the Editor: A mechanism by which warfarin and related compounds may cause skin and digital necrosis, which Roujeau and Stern do not. © 1995, Massachusetts Medical Society. All rights reserved.