PURPURA (Differential Diagnosis)- Palpable
- Vasculitis (Details see Case examples below)
- Although vasculitis can affect any organ, cutaneous involvement is generally seen with disorders that affect the small and medium vessels, and heart disease is usually limited to disorders that affect the medium and large vessels
- Skin findings include palpable purpura that may be ulcerated and involve dependent areas (i.e., areas below the heart that are affected by gravity)
- Patients with vasculitis often have constitutional symptoms and can also have other manifestations, depending on the type of inflammatory disease
- Infection (RMSF, Meningococcemia, DIC, Bacterial Endocarditis)
- Non-Palpable
- Primary Cutaneous Disorder
- Solar Purpura
- A variant of traumatic purpura called actinic purpura (otherwise known as Bateman’s purpura) commonly occurs in elderly patients who have severely sun-damaged skin. Ultraviolet-light–induced vessel fragility confers a pre- disposition to the development of recurring, irregularly shaped ecchymoses after even minor trauma. Lesions most commonly occur on the dorsal arms but can also be seen on the hands, neck, and face Case 2-2016
- Steroid Purpura
- Trauma
- Systemic Disease
- Vascular Fragility (Amyloidiosis, EDS, Scurvy)
- Coagulopathy Case 2-2016
- Bleeding Diathesis
- Acquired Causes: liver disease, use of anticoagulant and anti platelet medications, vitamin K deficiency, and massive transfusion
- Inherited Causes:
- Purpura Fulminans: Deficiency of Protein C, S or both.
- acute and rapidly progressive disorder in which intravascular thrombosis results in tissue necrosis and DIC
- Patients present with rapidly progressive purpura, which evolves into hemorrhagic bullae and necrosis. Fever is common, and patients have an increased bleeding time and decreased clotting factors
- Emboli (Fat, Cholesterol)
Purpura fulminates 10 years after contaminated cocaine use Lancet 2015
Case 14-2005: A 38-Year-Old Man with Fever and Blurred Vision (DDx: Purpura, Classification: Vasculitis)
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