Actinic Purpura Clinical Presentation
- Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD more...
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.
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.
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.
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