eMedicine Specialties > Dermatology > Diseases of the Vessels

Actinic Purpura: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Vinay Arya, MD, Staff Physician, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine; George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
Contributor Information and Disclosures

Updated: May 12, 2008

Differential Diagnoses

Amyloidosis, Primary Systemic
Pseudoxanthoma Elasticum

Other Problems to Be Considered

Purpura induced by topical or systemic glucocorticoid use
Hemophilia
Anticoagulant use (eg, aspirin, warfarin)
Vitamin K deficiency
Disseminated intravascular coagulation
Idiopathic thrombocytopenic purpura
Coumarin necrosis
Hepatic insufficiency with poor procoagulant synthesis
Psychogenic purpura
Physical abuse
Other causes of cutaneous pseudovasculitis

Cutaneous pseudovasculitis is a heterogeneous collection of disorders that manifest as purpura.4  They may be caused by vessel wall deposition of metabolic substances (amyloid, calcium), nutritional deficiencies (scurvy), nonvasculitic inflammatory purpura (pigmented purpuric dermatitis, arthropod reactions, viral and drug reactions), degeneration of the vessel wall and supporting stroma (senile/solar purpura), direct vessel wall invasion of infective organisms, coagulation-fibrinolytic disorders (eg, thrombocytopenia), and vessel wall trauma.

Workup

Laboratory Studies

  • The diagnosis of actinic purpura is usually obvious at clinical examination. Laboratory investigation is not required unless the diagnosis is not readily apparent.
  • Findings of the following tests are in the reference ranges:
    • Complete blood cell count
    • Coagulation studies
    • Platelet count determination
    • Liver function studies
    • Urinalysis
    • Stool guaiac test

Histologic Findings

Biopsy reveals a thinned epidermis with many abnormal keratinocytes in a disorderly pattern. The upper dermis contains extravasated red blood cells and hemosiderin without evidence of inflammatory cells. At histologic evaluation, solar elastosis can be appreciated in the surrounding skin as faintly blue homogenized elastotic material lying just below a layer of normal connective tissue at the base of the epidermis. The amount of abnormal elastic fibers is markedly increased, and the amount of collagen is decreased.

More on Actinic Purpura

Overview: Actinic Purpura
Differential Diagnoses & Workup: Actinic Purpura
Treatment & Medication: Actinic Purpura
Follow-up: Actinic Purpura
References
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References

  1. Bateman T. Exanthemata. In: A Practical Synopsis of Cutaneous Diseases. London, England: Longman, Hurst, Reese and Brown; 1818:118-9.

  2. Kaya G, Saurat JH. Dermatoporosis: a chronic cutaneous insufficiency/fragility syndrome. Clinicopathological features, mechanisms, prevention and potential treatments. Dermatology. 2007;215(4):284-94. [Medline].

  3. Shuster S. Osteoporosis, a unitary hypothesis of collagen loss in skin and bone. Med Hypotheses. 2005;65(3):426-32. [Medline].

  4. Carlson JA, Chen KR. Cutaneous pseudovasculitis. Am J Dermatopathol. Feb 2007;29(1):44-55. [Medline].

  5. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. Dec 1987;123(12):1638-43. [Medline].

  6. Berneburg M, Plettenberg H, Krutmann J. Photoaging of human skin. Photodermatol Photoimmunol Photomed. Dec 2000;16(6):239-44. [Medline].

  7. Bockholdt B, Maxeiner H, Hegenbarth W. Factors and circumstances influencing the development of hemorrhages in livor mortis. Forensic Sci Int. May 10 2005;149(2-3):133-7. [Medline].

  8. Chong BH, Ho SJ. Autoimmune thrombocytopenia. J Thromb Haemost. Aug 2005;3(8):1763-72. [Medline].

  9. DeBuys HV, Levy SB, Murray JC, Madey DL, Pinnell SR. Modern approaches to photoprotection. Dermatol Clin. Oct 2000;18(4):577-90. [Medline].

  10. Feinstein RJ, Halprin KM, Penneys NS, Taylor JR, Schenkman J. Senile purpura. Arch Dermatol. Aug 1973;108(2):229-32. [Medline].

  11. Goldstein DA, Schteingart MT, Birnbaum AD, Tessler HH. Bilateral eyelid ecchymoses and corneal crystals: an unusual presentation of multiple myeloma. Cornea. Aug 2005;24(6):757-8. [Medline].

  12. Griffiths CE, Wang TS, Hamilton TA, Voorhees JJ, Ellis CN. A photonumeric scale for the assessment of cutaneous photodamage. Arch Dermatol. Mar 1992;128(3):347-51. [Medline].

  13. Jackson R. Elderly and sun-affected skin. Distinguishing between changes caused by aging and changes caused by habitual exposure to sun. Can Fam Physician. Jun 2001;47:1236-43. [Medline].

  14. Joshi RS, Phadke VA, Khopkar US, Wadhwa SL. Unilateral solar purpura as a manifestation of asymmetrical photodamage in taxi drivers. Arch Dermatol. Jun 1996;132(6):715-6. [Medline].

  15. Kalivas L, Kalivas J. Solar purpura. Arch Dermatol. Jan 1988;124(1):24-5. [Medline].

  16. Kligman AM. Early destructive effect of sunlight on human skin. JAMA. Dec 29 1969;210(13):2377-80. [Medline].

  17. Lawrence N. New and emerging treatments for photoaging. Dermatol Clin. Jan 2000;18(1):99-112. [Medline].

  18. Ohnishi T, Nagayama T, Morita T, Miyazaki T, Okada H, Ohara K, et al. Angioma serpiginosum: a report of 2 cases identified using epiluminescence microscopy. Arch Dermatol. Nov 1999;135(11):1366-8. [Medline].

  19. Ohnishi Y, Tajima S, Akiyama M, Ishibashi A, Kobayashi R, Horii I. Expression of elastin-related proteins and matrix metalloproteinases in actinic elastosis of sun-damaged skin. Arch Dermatol Res. Jan 2000;292(1):27-31. [Medline].

  20. Rallis TM, Bakhtian S, Pershing LK, Krueger GG. Effects of 0.1% retinoic acid on Bateman's actinic purpura. Arch Dermatol. Apr 1995;131(4):493-5. [Medline].

  21. Seo JY, Lee SH, Youn CS, Choi HR, Rhie GE, Cho KH, et al. Ultraviolet radiation increases tropoelastin mRNA expression in the epidermis of human skin in vivo. J Invest Dermatol. Jun 2001;116(6):915-9. [Medline].

  22. Shuster S, Scarborough H. Senile purpura. Q J Med. Jan 1961;117:33-40.

  23. Singer RS, Hamilton TA, Voorhees JJ, Griffiths CE. Association of asymmetrical facial photodamage with automobile driving. Arch Dermatol. Jan 1994;130(1):121-3. [Medline].

  24. Sugimoto M, Takada T, Yasuda H, Nagashima I, Amano H, Yoshida M, et al. MPR-hCT imaging of the pancreatic fluid pathway to Grey-Turner's and Cullen's sign in acute pancreatitis. Hepatogastroenterology. Sep-Oct 2005;52(65):1613-6. [Medline].

  25. Tattersall RN, Seville R. Senile purpura. Q J Med. Apr 1950;19:151-9.

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Further Reading

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Keywords

Bateman actinic purpura, solar purpura, senile purpura, ultraviolet radiation–induced skin changes, chronic sun exposure

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Vinay Arya, MD, Staff Physician, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine
Vinay Arya, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

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, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Julie R Kenner, MD, PhD, Consultant, Clinical Research, Medical Affairs, VaxGen, Inc; Private Practice, Kenner Dermatology Center
Julie R Kenner, MD, PhD is a member of the following medical societies: American Academy of Dermatology and American Society of Tropical Medicine and Hygiene
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

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