[Ecchymotic patches of the fingers and Gardner-Diamond vascular purpura]

Ecchymotic patches on the fingers and vascular purpura in Gardner-Diamond syndrome are two benign but recurrent clinical disorders occurring chiefly in young women. They involve superficial cutaneous hemorrhagic signs. Both disorders testify to microvascular fragility without perturbation of general hemostasis. Diagnosis is easy for those familiar with the disorders. Ecchymotic episodes accompanied by sharp pain begin at the roots of the fingers. Microtraumatism is soon seen to be involved. Ecchymosis develops at the flexor muscles of the fingers but "capillary" resistance is only reduced in one third of cases. The pathogenic explanation involves rupture of a small post-capillary vein due to disorders in the control system of kinins and local metabolites. The autoerythrocyte sensitization syndrome described in 1955 by Gardner and Diamond is characterized by painful and febrile episodes followed by purpuric and ecchymotic lesions of the skin on various parts of the body, but not necessarily on the legs. Dysneurotonic effects are frequent but diagnosis is based upon promotion of the disorder by intradermal or subcutaneous injection of a minimal quantity of autologous blood. Immunological effects are considered but the ailment involves microvascular control disorders, notably of the capillary-vein segment, in particular at Copley's endo-endothelial fibrin film. Imbalance in fibrin formation and lysis is associated with perturbation of the kinin and serotonin systems. In addition to the use of certain bioflavonoids and calcium inhibitors, prevention and treatment should involve consideration of drugs which affect plasticity in the vascular wall and pericapillary interstitial conjunctiva and the rheological properties of blood flow and interstitial tissue.