Approach to purpura
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Purpura is defined as extravasation of red blood cells resulting in discoloration of the skin or mucous membranes secondary to any disturbance of the normal physiological mechanisms that normally prevent blood from escaping from the vessels, or from damage or lack of support to the vasculature. It is an important and easily recognizable sign and can occur isolated or as part of a systemic disorder. The causes of purpura range from trivial (actinic/senile purpura) to extremely alarming and life-threatening conditions (vasculitis) that need to be diagnosed and treated early. The most common causes of purpura are due to platelet and coagulation disorders, which are generally dealt with by hematologists. For dermatologists, two major disease groups presenting with purpura are vasculitis affecting small and medium-sized cutaneous vessels and cutaneous vascular occlusion syndromes. Microvascular occlusion syndromes are important to recognize because they may mimic vasculitis but require a different approach to diagnosis and therapy [1].
Skin
A Sahib El-Radhi, James Carroll in Paediatric Symptom Sorter, 2017
The normal haemostatic mechanisms are complex but primarily are based on vascular response (vasoconstriction and retraction of blood vessels), decrease in blood flow to the affected area, platelet clot formation and activation of coagulation factors to form fibrin to stabilise the clot. Purpura is due to vasculopathy, thrombocytopathy, coagulopathy or a combination of these mechanisms. It indicates extravasation of blood into the skin or mucosal membranes. Lesions are not raised. Purpura may represent a benign condition or a serious underlying disorder such as meningococcal septicaemia (MCS). Depending on their size, lesions are either petechiae (pinpoint haemorrhages of < 1 cm, usually < 2 mm, in diameter) or ecchymoses (> 1 cm in diameter). In contrast to exanthem and telangiectasia, purpura does not blanch on pressure. In neonates, petechiae are commonly observed on the presenting part during delivery, particularly if the delivery was traumatic. In late infancy and toddlers, bruises frequently occur over bony prominences such as shins, knees and forehead.
Granulomatous Diseases
Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang in Roxburgh's Common Skin Diseases, 2022
Overview: Purpuric eruptions are subdivided into two types: non-thrombocytopenic (normal platelet) and thrombocytopenic (low platelet). Purpura may result from compromising the vessel walls (trauma, infection, vasculitis, collagen disorders) or due to hemostatic pathology (thrombocytopenia, abnormal platelet function, clotting factor deficiency, or abnormal clotting factor function). Other conditions may be associated with petechiae, including septicemia, immune thrombocytopenia (ITP), hemolytic uremic syndrome, leukemia, and coagulopathies (e.g., hemophilia). Non-thrombocytopenic purpura may result from coagulation disorders, connective tissue disorders, scurvy, or vasculitis. Thrombocytopenic purpura may be due to medications, immune disorders, septicemia, Rocky Mountain spotted fever, or systemic lupus erythematous.
Periocular amyloid papules as a presenting sign in multiple myeloma
Published in Clinical and Experimental Optometry, 2020
Alexandra Scherk, Alanna Khattar
Melasma, which was the preliminary diagnosis, are flat grey‐brown patches which occur when the melanocytes in the skin produce excess pigment. These lesions can be triggered by sun exposure, changes in hormones or skin care products, none of which were present for the patient in this case. Xanthoma is an accumulation of lipids which usually occur secondary to high cholesterol levels.2016 The patient in this case did not exhibit elevated levels of cholesterol. Papillomas are benign lesions that can present in various shapes, sizes, and colours. These lesions can present in isolation or in multiples, unilaterally or bilaterally. Purpura are small purple spots on the skin which can be signs of platelet disorders, infectious diseases such as human immunodeficiency virus, or amyloidosis.2006 The patient in this case did not present with any purple or bruise‐like lesions. Ultimately, a biopsy was used in this case to determine the aetiology of the eyelid lesion.
Sinonasal and respiratory outcomes of eosinophilic granulomatosis with polyangiitis patients receiving 100 mg mepolizumab in real-life clinical practice: 1-year follow up study
Published in Journal of Asthma, 2023
Ozge Can Bostan, Emine Duran, Gulseren Tuncay, Melek Cihanbeylerden, Omer Karadag, Ebru Damadoglu, Gul Karakaya, Ali F. Kalyoncu
The determination of migrating pulmonary infiltrates or pleural effusion on computed tomography (CT) scan or chest x-ray was considered pulmonary involvement. Due to recent studies demonstrating the association of severe asthma and EGPA with bronchiectasis, the presence of bronchiectasis on CT was also noted and classified (19–24). Palpable purpura on the skin that could not be explained by other reasons or confirmed by skin biopsy was considered skin involvement. Chronic rhinosinusitis, nasal polyps, paranasal sinus involvement supported by imaging studies were evaluated as upper respiratory tract involvement, and mononeuritis multiplex or polyneuropathy supported by EMG as peripheral nerve involvement. Intestinal vasculitis, eosinophilic esophagitis or gastroenteritis were evaluated as gastrointestinal involvement. Myocarditis, pericardial effusion, myopericarditis, endomyocardial fibrosis, or ischemic heart disease due to vasculitis demonstrated on echocardiography were accepted as cardiac involvement. Proteinuria >500 mg/24 h, and hematuria (>5-10 red blood cells per high power field (hpf) in urine), supporting biopsy or renal failure due to renal vasculitis were evaluated as renal involvement. Arthralgia, arthritis, myalgia, or myositis were evaluated as musculoskeletal involvement (25).
Clinical spectrum of immunoglobulin A vasculitis in children and determining the best timing of urine examination to predict renal involvement
Published in Postgraduate Medicine, 2022
Fatma Yazılıtaş, Evrim Kargın Çakıcı, Eda Didem Kurt Şükür, Semanur Özdel, Tülin Güngör, Esra Bağlan, Evra Çelikkaya, Deniz Karakaya, Diclehan Orhan, Mehmet Bülbül
Among our 178 patients with IgA vasculitis, whose median age was 6.5 years (mean age 7.1 ± 3.0 years; range 2.2 to 17.8 years) at presentation, boys constituted 51.1% of (n: 91). Purpura was present in all patients. All patients had vasculitic purpuric rash at the time of diagnosis. The season of the diagnosis with the highest number of IgA vasculitis patients was autumn (n = 65, 36.5%), followed by winter (n = 42, 23.6%), and spring (n = 49, 27.5), whereas the smallest number of patients were observed in summer (n = 22, 12.3%). A total of 24 (13.5%) patients had renal involvement. There were no significant sex differences in patients with or without renal involvement (p = 0.46). The median age was significantly higher in patients with abnormal urine analysis compared with those with normal urine analysis [6.9 ± 2.8 years vs. 8.2 ± 2.9 years, p = 0.040]. The largest proportion of renal involvement occurred among patients who presented during the spring season (p = 0.009). The clinical and demographic characteristics and laboratory values of patients are summarized in Table 1.
Related Knowledge Centers
- Bleeding
- Meningitis
- Neisseria Meningitidis
- Petechia
- Typhus
- Bruise
- Skin
- Blanch
- Sepsis
- Gram-Negative Bacteria