Acral necrosis

Acral necrosis
A hand with acral gangrene due to plague

WikiDoc Resources for Acral necrosis
Articles
Most recent articles on Acral necrosis Most cited articles on Acral necrosis Review articles on Acral necrosis Articles on Acral necrosis in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Acral necrosis Images of Acral necrosis Photos of Acral necrosis Podcasts & MP3s on Acral necrosis Videos on Acral necrosis
Evidence Based Medicine
Cochrane Collaboration on Acral necrosis Bandolier on Acral necrosis TRIP on Acral necrosis
Clinical Trials
Ongoing Trials on Acral necrosis at Clinical Trials.gov Trial results on Acral necrosis Clinical Trials on Acral necrosis at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Acral necrosis NICE Guidance on Acral necrosis NHS PRODIGY Guidance FDA on Acral necrosis CDC on Acral necrosis
Books
Books on Acral necrosis
News
Acral necrosis in the news Be alerted to news on Acral necrosis News trends on Acral necrosis
Commentary
Blogs on Acral necrosis
Definitions
Definitions of Acral necrosis
Patient Resources / Community
Patient resources on Acral necrosis Discussion groups on Acral necrosis Patient Handouts on Acral necrosis Directions to Hospitals Treating Acral necrosis Risk calculators and risk factors for Acral necrosis
Healthcare Provider Resources
Symptoms of Acral necrosis Causes & Risk Factors for Acral necrosis Diagnostic studies for Acral necrosis Treatment of Acral necrosis
Continuing Medical Education (CME)
CME Programs on Acral necrosis
International
Acral necrosis en Espanol Acral necrosis en Francais
Business
Acral necrosis in the Marketplace Patents on Acral necrosis
Experimental / Informatics
List of terms related to Acral necrosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Acral necrosis is the black discoloration of the skin of the extremities due to decreased blood supply to the afftected areas. Acral necrosis is a common symptom of bubonic plague.

Historical Perspective

The striking black discoloration of skin and tissue, primarily on the extremities, is commonly thought to have given rise to the name "Black Death," associated both with the disease and the pandemic which occurred in the 14th century. The term in fact came from the figural sense of "black", that is glum, lugubrious or dreadful.

Pathophysiology

Clotting and bleeding beneath the skin causes an area of hemorrhage, the presence of red blood cells lying outside of capillaries, into the skin and subcutaneous tissue. In isolation, this is called an ecchymosis or bruise and may be the result of injury or illness. However, acral necrosis occurs when blood supply is disrupted for prolonged periods, blackening and damaging the affected area and surrounding tissue.

Gross Pathology

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

• 
  Hand: Gangrene: Gross excellent demonstration of gangrenous necrosis of fingers
• 
  Hand: Gangrene: Gross excellent demonstration of gangrenous necrosis of fingers

• 
  Hand: Gangrene: Gross excellent demonstration of gangrenous necrosis of fingers
• 
  Necrosis of distal finger in a patient with panniculitis and fascitis, streptococcus A septicemia in a patient with Scleroderma who was on high dose steroids

Causes

Common Causes

• Bubonic plague
• Peripheral vascular disease
• Pneumonic plague
• Raynaud's disease

Causes by Organ System

Cardiovascular	Antiphospholipid Antibody Syndrome, arteriovenous fistula, atherosclerosis, borrelia infection, cutaneous polyarteritis nodosa, diabetes mellitus, heparin induced thrombocytopenia, hypereosinophilic syndrome, scleroderma, Sharp syndrome, vasculitis
Chemical/Poisoning	Biological warefare agents, carbon monoxide poisoning
Dental	No underlying causes
Dermatologic	Antiphospholipid Antibody Syndrome, arteriovenous fistula, borrelia infection, bubonic plague, calcific azotemic arteriopathy, chronic renal failure, cryofibrinogenemia, cutaneous polyarteritis nodosa, deep vein thrombosis, diabetes mellitus, erythromelagia, fasciitis, frostbite, heparin induced thrombocytopenia, hypereosinophilic syndrome, panniculitis, peripheral vascular disease, pneumonic plague, polyangiitis overlap syndrome, primary hyperoxaluria type 1, purpura fulminans, Raynaud's disease, scleroderma, Sharp syndrome, T-cell lymphoma, vasculitis, Waldenstrom's macroglobulinemia
Drug Side Effect	Bleomycin, capecitabine, coumarin, doxorubicin, gemcitabine, heparin induced thrombocytopenia, quinine, vinblastine, vincristine, warfarin
Ear Nose Throat	Vasculitis, Waldenstrom's macroglobulinemia
Endocrine	Diabetes mellitus
Environmental	No underlying causes
Gastroenterologic	Bubonic plague, chronic renal failure, cutaneous polyarteritis nodosa, diabetes mellitus, fasciitis, scleroderma, hypereosinophilic syndrome, vasculitis
Genetic	Primary hyperoxaluria type 1
Hematologic	Antiphospholipid Antibody Syndrome, cryofibrinogenemia, heparin induced thrombocytopenia, polyangiitis overlap syndrome, primary hyperoxaluria type 1, purpura fulminans, Sharp syndrome
Iatrogenic	No underlying causes
Infectious Disease	Borrelia infection, bubonic plague, fasciitis, panniculitis, pneumonic plague, sternotrophomonas maltophilia
Musculoskeletal/Orthopedic	Antiphospholipid Antibody Syndrome, arteriovenous fistula, atherosclerosis, borrelia infection, bubonic plague, chronic renal failure, cutaneous polyarteritis nodosa, deep vein thrombosis, diabetes mellitus, erythromelagia, frostbite, heparin induced thrombocytopenia, peripheral vascular disease, polyangiitis overlap syndrome, Raynaud's disease, scleroderma, Sharp syndrome, T-cell lymphoma, vasculitis, Waldenstrom's macroglobulinemia
Neurologic	Antiphospholipid Antibody Syndrome, arteriovenous fistula, atherosclerosis, borrelia infection, bubonic plague,chronic renal failure, cutaneous polyarteritis nodosa, diabetes mellitus, frostbite, hypereosinophilic syndrome, peripheral vascular disease, pneumonic plague, vasculitis, Waldenstrom's macroglobulinemia
Nutritional/Metabolic	Diabetes mellitus, primary hyperoxaluria type 1
Obstetric/Gynecologic	Antiphospholipid Antibody Syndrome, chronic renal failure
Oncologic	T-cell lymphoma
Ophthalmologic	Waldenstrom's macroglobulinemia
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Arteriovenous fistula, bubonic plague, chronic renal failure, deep vein thrombosis, heparin induced thrombocytopenia, hypereosinophilic syndrome, pneumonic plague, scleroderma, Sharp syndrome, sternotrophomonas maltophilia, vasculitis
Renal/Electrolyte	Calcific azotemic arteriopathy, chronic renal failure, diabetes mellitus, polyangiitis overlap syndrome, primary hyperoxaluria type 1, scleroderma, vasculitis
Rheumatology/Immunology/Allergy	Antiphospholipid Antibody Syndrome, polyangiitis overlap syndrome, Sharp syndrome
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Primary hyperoxaluria type 1, sternotrophomonas maltophilia, vasculitis
Miscellaneous	Bubonic plague, chronic renal failure, cutaneous polyarteritis nodosa, erythromelagia, fasciitis, pneumonic plague

Causes in Alphabetical Order

• Antiphospholipid Antibody Syndrome
• Arteriovenous fistula
• Atherosclerosis
• Biological warefare agents
• Bleomycin
• Borrelia infection
• Bubonic plague
• Calcific azotemic arteriopathy
• Capecitabine
• Carbon monoxide poisoning
• Chronic renal failure
• Coumarin
• Cryofibrinogenemia
• Cutaneous polyarteritis nodosa
• Deep vein thrombosis
• Diabetes mellitus
• Doxorubicin
• Erythromelagia
• Fasciitis
• Frostbite
• Gemcitabine
• Heparin induced thrombocytopenia
• Hypereosinophilic syndrome
• Panniculitis
• Peripheral vascular disease
• Pneumonic plague
• Polyangiitis overlap syndrome
• Primary hyperoxaluria type 1
• Purpura fulminans
• Quinine
• Raynaud's disease
• Scleroderma
• Sharp syndrome
• Sternotrophomonas maltophilia
• T-cell lymphoma
• Vasculitis
• Vinblastine
• Vincristine
• Waldenstrom's macroglobulinemia
• Warfarin

Natural History, Complications and Prognosis

Untreated cases can lead to death.

Treatment

With appropriate medical treatment, areas with acral necrosis may be successfully restored to function.