Pigmented Purpuric Dermatoses

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Group of diseases characterized by petechial hemorrhage thought to be secondary to capillaritis.
  • AKA Benign Pigmented Purpura
  • Five main variants
    • Shamberg’s purpura
    • Lichenoid purpura of Gougerot-Blum
    • Purpura Annularis Telangiectodes (Majocchi’s disease)
    • Lichen Aureus
    • Eczematous dermatitis of Ducas and Kapetanakis
  • May be pruritic
  • Clustered petechial hemorrhage
  • Capillaritis, lymphocytic “vasculitis”
 
Treatment
  • Difficult to treat
  • Topical steroids
  • Pentoxifylline
  • Ascorbic acid (500mg 2id) + rutoside (50mg 2id)
  • Phototherapy (nbUVB, PUVA)
  • Some may represent an allergic response to textile dyes (disperse blue, disperse red)
 
Schamberg’s disease
  • Prototypical and most common
  • Thumbprint sized and composed of pinhead-sized petechiae resembling cayenne pepper with golden-brown hemosiderin staining
  • Lower extremities and ankles
 
Lichenoid Purpura or Gougerot-Blum Syndrome
  • Lichenoid dermatitis
  • Minute, rust-colored to violaceous, lichenoid papules that coalesce into plaques
  • Legs, thighs, and trunk
 
Purpura Annularis Telangiectoides (Majocchi’s disease)
  • Bluish-red 1 to 3cm annular patches with dark telangiectasias and petechiae
  • Symmetrically over lower extremities and may spread up legs
 
Lichen Aureus
  • Solitary to few
  • Golden or rust-colored, closely packed macules or lichenoid papules
  • May be related to incompetent perforator valve causing increased venous and capillary pressure
 
Eczematid-like purpura of Doucas and Kapetanakis
  • Scaly and eczematous
  • Presence of spongiosis on biopsy
 
Linear pigmented purpura
Granulomatous pigmented purpura