Spontaneous skin tearing during systemic corticosteroid treatment

A 52-year-old woman with rheumatoid arthritis experienced painless spontaneous hemorrhage, tearing, and necrosis of the skin on the lower laternal aspect of both legs. Thereapy with systemic prednisone had been used to suppress active synovitis for almost four years and was associated with moon facies, hirsutism, truncal obesity, thinning of the skin, extensive purpura on the extremities, and other manifestations of hypercortisolism. There was no evidence of rheumatoid vasculitis, trauma, or blood dyscrasia. The leg lesions may represent an exaggerated type of steroid-induced purpura resulting in localized areas of gangrenous skin.