Actinic Purpura Differential Diagnoses

Updated: Apr 07, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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DDx

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 [11]
  • Physical abuse
  • Other causes of cutaneous pseudovasculitis

Cutaneous pseudovasculitis is a heterogeneous collection of disorders that manifest as purpura. [12] 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. [13] 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. [14]

The breakdown of previously inserted intravascular devices may produce microemboli that mimic senile purpura and have subtle histologic findings. [15]

Differential Diagnoses