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Actinic Purpura Differential Diagnoses

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

Diagnostic Considerations

Also consider the following:

  • 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 [8]
  • Physical abuse
  • Other causes of cutaneous pseudovasculitis

Cutaneous pseudovasculitis is a heterogeneous collection of disorders that manifest as purpura.[9] 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.

Purpuric eruptions on photoexposed skin has been described.[10] Medications such as levofloxacin may produce phototoxicity with a pruritic purpuric of confluent petechiae limited to sun-exposed areas and accompanied by pruritus.

Actinic purpura with inflammatory changes may simulate leukocytoclastic vasculitis or neutrophilic dermatosis.[11]

The breakdown of previously inserted intravascular devices may produce microemboli that mimic senile purpura and have subtle histologic findings.[12]

Differential Diagnoses

 
 
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
  1. Bateman T. Exanthemata. 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. Borroni RG, Grassi S, Concardi M, Agozzino M, Caspani C, Giordano C, et al. Involvement of dermal microvascular basement membrane in senile purpura: quantitative immunohistochemical study. J Eur Acad Dermatol Venereol. 2015 Sep 25. [Medline].

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  8. Jafferany M, Bhattacharya G. Psychogenic Purpura (Gardner-Diamond Syndrome). Prim Care Companion CNS Disord. 2015. 17 (1):[Medline].

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

  10. Rubegni P, Feci L, Pellegrino M, Fimiani M. Photolocalized purpura during levofloxacin therapy. Photodermatol Photoimmunol Photomed. 2012 Apr. 28(2):105-7. [Medline].

  11. Wood BA, Leboit PE. An 'inflammatory' variant of solar purpura: a simulant of leukocytoclastic vasculitis and neutrophilic dermatoses. Pathology. 2013 Aug. 45(5):484-8. [Medline].

  12. Hardy CL, Glass JS, Sorrells T, Nicholas LC. Hemorrhagic Panniculitis Caused by Delayed Microemboli From Intravascular Device. JAMA Dermatol. 2014 Oct 1. [Medline].

  13. Northcutt AD, Tschen JA. The routine use of iron stain for biopsies of dermatoses of the legs. J Cutan Pathol. 2014 Feb 12. [Medline].

  14. Lipozencic J, Bukvic Mokos Z. Dermatologic lasers in the treatment of aging skin. Acta Dermatovenerol Croat. 2010 Sep. 18(3):176-80. [Medline].

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

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

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

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

 
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