Medical Care
No medical intervention is of consistent benefit for the treatment of the pigmented purpuric dermatoses.
Pruritus may be alleviated by the use of topical corticosteroids and antihistamines.
Associated venous stasis should be treated by compression hosiery.
Prolonged leg dependency should be avoided.
The use of narrowband UVB and psoralen plus UVA have shown to be effective treatments for some patients with pigmented purpuric dermatoses. [24, 25, 26, 27, 28]
Tamaki et al reported successful treatment of pigmented purpuric dermatoses using griseofulvin. [29] Treatment with oral cyclosporin has also been successful. [30]
Successful therapy with ascorbic acid (500 mg twice daily) and rutoside (50 mg twice daily) has also been reported. [31] Anecdotal data exist for calcineurin-inhibitors, colchicine, pentoxifylline, immunosuppressants, ultraviolet therapy, and laser therapy. [32]
Long-Term Monitoring
A follow-up consultation is required for cases in which initially diagnostic uncertainty exists, particularly to exclude cutaneous lymphoma.
Topical steroid treatment if used long term should be monitored for the possible development of adverse effects.
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Pigmented purpuric dermatitis affecting the trunk. Some of the lesions show the characteristic orange-brown, speckled, cayenne pepper–like discoloration that is the hallmark clinical sign of a capillaritis. Men are more frequently affected than women. If the lesions are pruritic, then the term itching purpura is sometimes used. Early cutaneous T-cell lymphoma, purpuric clothing contact dermatitis, and drug hypersensitivity reactions should be considered in the differential diagnosis.
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Lichen aureus is the name given to localized pigmented purpuric dermatitis or capillaritis. In this patient, the skin on the extensor surface of the elbow is affected.
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Histologic features of a skin biopsy sample obtained from a patient with lichen aureus shows extravasation of erythrocytes and a perivascular T-cell infiltrate.
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Endothelial cell swelling is a histologic feature of capillaritis. This biopsy sample was obtained from a patient with lichen aureus.
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Hemosiderin deposition is seen in dermal macrophages in this biopsy sample obtained from a patient with lichen aureus.
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Capillaritis affecting the lower legs is known as Schamberg disease. In Schamberg disease, irregular plaques and patches of orange-brown pigmentation develop on the lower limbs.
