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Actinic Purpura Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
 
Updated: Jun 22, 2016
 

History

Patients may report the appearance of purple blotches or bruises on their forearms, hands, face, or neck. The macules are not associated with pain or pruritus.

Constitutional symptoms (eg, fever, malaise, weight loss) are absent.

The patient may report a history of the lesions resolving and then subsequently reappearing. Residual brown pigmentation may appear after the purpuric macules resolve. Individual lesions usually last 1-3 weeks, and they do not undergo the color changes that occur with other types of purpuric lesions.

Patients are typically unaware of any external trauma that may have been responsible for the ecchymoses. Individuals may report a history of chronic sun exposure to skin sites where lesions are present. Individuals with actinic purpura are often taking blood-thinning medications such as aspirin or warfarin, which can aggravate the condition.

An asymptomatic petechial eruption after strong sun exposure may occur, sometimes with an action spectrum within the ultraviolet A waveband.[6]

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Physical

Purpuric patches and macules larger than 3 mm in diameter are usually present on the extensor surfaces of the forearms and on the dorsa of the hands; the lesions do not extend onto the fingers. Ecchymoses may also be found on the neck and face. Macules and patches are dark purple and irregularly shaped. A sharp margin is seen between the borders of the lesions and the surrounding skin.

Some macules are more deeply colored than others because the duration of the lesions varies. The color changes that are typically associated with purpura or ecchymoses due to other causes do not occur, although residual brown pigmentation may persist.

Lesions of actinic purpura occur in areas of atrophic and inelastic photodamaged skin. Other signs of dermatoheliosis often present include leathered wrinkling, stellate pseudoscars, and a sallow yellow hue to the skin. Lentigines and scars may be present. The skin may appear darker secondary to hyperpigmentation due to hemosiderosis.

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Causes

Chronic sun exposure leads to skin changes that predispose patients to actinic purpura. Because of the ultraviolet-induced atrophy, the connective tissue of the dermis is no longer able to adequately support the microvasculature. As a result, even minor trauma can tear the blood vessels, leading to the extravasation of blood. In fact, the development of actual skin tears is understandably linked in elderly persons with ecchymoses and senile purpura.[7]

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

George Kihiczak, MD Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Julie R Kenner, MD, PhD Private Practice, Kenner Dermatology Center

Julie R Kenner, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Vinay Arya, MD, to the development and writing of this article.

References
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