October 1986

The Cutaneous Manifestations of Cholesterol Crystal Embolization

Author Affiliations

From the Department of Dermatology (Dr Falanga) and Internal Medicine (Drs Fine and Kapoor), University of Pittsburgh School of Medicine, Pittsburgh. Dr Falanga is now with the Department of Dermatology and Cutaneous Surgery, University of Miami.

Arch Dermatol. 1986;122(10):1194-1198. doi:10.1001/archderm.1986.01660220112024

• In an effort to provide a greater understanding of the cutaneous features of cholesterol crystal embolization (CCE), we reviewed the clinical features of all histologically proved cases reported in the English-language literature, exclusive of cases in which there was only central nervous system or cardiac involvement. We found that the skin is involved in 35% of patients with CCE. Livedo reticularis is the most common skin manifestation (49%), followed by gangrene (35%), cyanosis (28%), ulceration (17%), nodules (10%), and purpura (9%). Cholesterol crystal embolization was most common in older men and was frequently associated with anticoagulant therapy (36%) or vascular procedures (31%). Because of its protean systemic manifestations, CCE was often mistaken for vasculitis (16%) and periarteritis nodosa (12%). Mortality was very high (72%). Histologic confirmation of cutaneous CCE was possible in 92% of cases where a skin biopsy specimen was obtained. We conclude that the diagnosis of cutaneous CCE should be suggested and easily confirmed histologically in the appropriate clinical setting.

(Arch Dermatol 1986;122:1194-1198)