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Purpura simplex (inflammatory purpura without vasculitis): a clinicopathologic study of 174 cases
K V Ratnam1, W P Su, M S Peters
1Department of Dermatology, Mayo Clinic, Rochester, MN 55905.
Abstract:
Purpura simplex manifests clinically as macular purpuric and petechial pigmented, golden, annular, or lichenoid lesions. These subtypes have been termed Schamberg's purpura, lichen aureus, Majocchi's purpura, and Gougerot-Blum purpura. Histologically, there is inflammation and hemorrhage without fibrinoid necrosis of vessels. One hundred seventy-four cases were retrospectively reviewed. In some patients, the eruption was related to medications. Treatment was usually of limited benefit. Fifty-eight of 87 patients (67%) who had follow-up data did eventually have clearing of lesions. Because of the clinical and histologic similarities among the subtypes, the inclusive term purpura simplex is favored.
Insights
Purpura simplex presents with various skin lesions, including pigmented purpuric and petechial types. Many patients experience spontaneous clearing, supporting the use of this inclusive term for related conditions.
Area of Science:
- Dermatology
- Vascular Biology
Background:
- Purpura simplex encompasses several subtypes: Schamberg's purpura, lichen aureus, Majocchi's purpura, and Gougerot-Blum purpura.
- These conditions are characterized by macular purpuric and petechial lesions with specific pigmentations and morphologies.
- Histological findings include inflammation and hemorrhage, notably without fibrinoid necrosis of vessels.
Purpose of the Study:
- To review the clinical and histological features of purpura simplex subtypes.
- To evaluate the impact of medications and treatment on the condition.
- To determine the most appropriate classification for these related dermatological conditions.
Main Methods:
- Retrospective review of 174 patient cases.
- Analysis of clinical presentations, including lesion types and pigmentation.
- Histological examination to identify key pathological features.
- Assessment of treatment efficacy and patient follow-up data.
Main Results:
- The study identified various clinical manifestations, including pigmented, golden, annular, or lichenoid lesions.
- A subset of patients experienced eruptions potentially related to medication use.
- Treatment efficacy was generally limited, with spontaneous clearing observed in 67% of patients with follow-up data.
- Clinical and histological similarities were noted across the different subtypes.
Conclusions:
- The diverse clinical and histological features of Schamberg's purpura, lichen aureus, Majocchi's purpura, and Gougerot-Blum purpura suggest a common underlying process.
- The inclusive term 'purpura simplex' is favored due to the significant overlap in presentation and pathology.
- Further research may elucidate specific triggers and optimize management strategies for purpura simplex.