Acral purpura: an unusual sign of coumarin necrosis.

Coumarin necrosis, a rare complication of coumarin anticoagulation, typically presents with well-defined purpuric patches that progress to bullae formation and necrosis. The vast majority of those affected are women, and most commonly affected sites are the breasts, buttocks, thighs, and abdomen. We present a male patient who manifested a unique reticulated purpura that progressed to bullae formation on the toes of one foot in addition to more classic lesions on the thigh and calf.