Rare Case Links Apixaban to Severe Periorbital Dermatitis: Highlights Need for Vigilance in Dermatological Reactions

The case involved a 76-year-old woman who developed intense inflammation and irritation around her eyes, clinically referred to as periorbital dermatitis, approximately three weeks after initiating treatment with apixaban. Despite multiple therapeutic interventions over nearly two years, her symptoms remained unresolved.

The patient was prescribed several treatments, including antihistamines, topical corticosteroids of different potencies, calcineurin inhibitors, and emollients. However, none of these approaches brought lasting or meaningful relief. The breakthrough came after apixaban was discontinued and replaced with another anticoagulant, rivaroxaban. Following this change, the patient’s periorbital dermatitis showed complete resolution, strongly suggesting a causal relationship between apixaban and the skin condition.

Periorbital dermatitis, while relatively common as a dermatologic diagnosis, is seldom reported as a side effect of anticoagulant therapy. According to the authors, this is only the second case documented in medical literature implicating apixaban as a potential cause of this condition.

This case brings attention to the less-recognized cutaneous side effects of direct oral anticoagulants (DOACs), particularly apixaban. Apixaban is used widely for stroke prevention in atrial fibrillation and the management of venous thromboembolism. Its broad application makes awareness of potential side effects particularly important.

Clinicians are encouraged to maintain a high index of suspicion when encountering unexplained dermatological reactions in patients taking this medication.

The authors emphasize the value of considering adverse drug reactions in the differential diagnosis of new or treatment-resistant skin complaints. Identifying the offending agent early can help prevent unnecessary investigations and prolonged patient discomfort, as illustrated in this case.

The findings also support the potential benefit of switching anticoagulants when cutaneous side effects are suspected. Rivaroxaban, which belongs to the same class of drugs as apixaban but has a different molecular profile, was well tolerated by the patient and proved effective without inducing further dermatological issues.

This report aims to broaden clinical awareness and reinforce the need for thorough medication reviews in dermatologic assessments, especially in elderly patients with recent changes in their drug regimens.

"The case is presented to raise awareness among clinicians about the potential dermatologic side effects of apixaban and to highlight the importance of including medication-related reactions in the differential diagnosis of new or unexplained skin conditions," Kelsey Koenig, Waukesha Family Medicine Residency at Prohealth, Waukesha, Wisconsin, and colleagues concluded.

Reference:

Koenig K, Tews G, Downs A. Periorbital Dermatitis Induced by Apixaban. WMJ. 2025;124(1):67-68. PMID: 40262011.