Purpura and Microvascular Occlusion

Cox, Neil; Piette, Warren W.

doi:10.1002/9781444317633.ch49

Cited by 16 publications

(32 citation statements)

References 446 publications

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“…[1] It is rather resistant to treatment. Though the diagnosis is quite straightforward, the disease entity remains an enigma and a therapeutic challenge.…”

Section: Discussionmentioning

confidence: 99%

Clinicoepidemiological study of pigmented purpuric dermatoses

Sharma

Gupta

2012

Indian Dermatol Online J

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Background:Pigmented purpuric dermatoses (PPD) are a group of vascular disorders with varied manifestations which cause concern and are resistant to treatment. The literature is still lacking in clinicoepidemiological studies.Aim:To study the epidemiology, etiological, host and environmental factors, clinical manifestations, its variations, and the type prevalent in this part of the world.Materials and Methods:All cases of PPD were selected for the study from Skin and Venereal Disease, Out Patient Department between January 2008 and June 2009. Their history, examination, hematological investigations, and, in a few, histopathology findings were also recorded and data obtained were evaluated statistically.Results:There were 100 cases of PPD of total 55 323 patients (0.18%). There were 79 males and 21 females between 11 and 66 years. They were working as police men, security guards, barber, chemist, teachers, students, farmers, businessmen, and housewives. In a majority, there was a history of prolonged standing in day-to-day work. Purpuric, brownish pigmented, lichenoid or atrophic lesions were seen depending upon the type of PPD on lower parts of one or both lower limbs. Blood investigations were normal. Schamberg's disease was seen in ninety five, Lichen aureus in three, lichenoid dermatosis and Majocchi's disease in one case each.Discussion:Three clinical types of PPD were diagnosed which may represent different features of the same disease. Cell-mediated immunity, immune complexes, capillary fragility, gravitational forces, venous hypertension, focal infection, clothing, contact allergy to dyes, and drug intake have been incriminating factors in the past. Patient's occupation and environmental factors may also be considered contributory in precipitating the disease.Conclusions:The study revealed the problem of PPD in this geographical area, its magnitude, clinical presentation, the type prevalent, and possible aggravating factors to be kept in mind while managing the disease.

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“…[1] It is rather resistant to treatment. Though the diagnosis is quite straightforward, the disease entity remains an enigma and a therapeutic challenge.…”

Section: Discussionmentioning

confidence: 99%

Clinicoepidemiological study of pigmented purpuric dermatoses

Sharma

Gupta

2012

Indian Dermatol Online J

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“…Purpura is caused by hemorrhage of small vessels in the skin or mucous membranes and emerges as red or purple spots that do not blanch upon application of pressure on the lesion’s surface [3]. Usually, these skin lesions are a hallmark of coagulation disorders or vasculitis [3], such as disseminated intravascular coagulation, idiopathic thrombocytopenic purpura, Henoch-Schönlein purpura (HSP), or hypersensitivity (leukocytoclastic) vasculitis [3–7]. …”

Section: Introductionmentioning

confidence: 99%

Recurrent purpura due to alcohol-related Schamberg’s disease and its association with serum immunoglobulins: a longitudinal observation of a heavy drinker

2016

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BackgroundIt is unusual for purpura to emerge as a result of drinking alcohol. Such a peculiarity was observed in a 55-year-old man with a 30-year history of heavy alcohol use.Case presentationThe Caucasian patient was studied for 11 years during several detoxification treatments. During the last 2 years of that period, purpuric rashes were newly observed. The asymptomatic purpura was limited to both lower limbs, self-limiting with abstinence, and reoccurring swiftly with alcohol relapse. This sequence was observed six times, suggesting a causative role of alcohol or its metabolites. A skin biopsy revealed histological features of purpura pigmentosa progressiva (termed Schamberg’s disease). Additionally, alcoholic fatty liver disease markedly elevated serum immunoglobulins (immunoglobulin A and immunoglobulin E), activated T-lymphocytes, and increased C-reactive protein. In addition, moderate combined (cellular and humoral) immunodeficiency was found. Unlike the patient’s immunoglobulin A level, his serum immunoglobulin E level fell in the first days of abstinence, which corresponded to the time of purpura decline. Systemic vasculitis and clotting disorders were excluded. The benign character of the purpura was supported by missing circulating immune complexes or complement activation. An alcohol provocation test with vinegar was followed by the development of fresh “cayenne pepper” spots characteristic of Schamberg’s disease.ConclusionsThis case report demonstrates that Schamberg’s disease can be strongly related to alcohol intake, in our patient most likely as a late complication of severe alcoholism with alcoholic liver disease. Immunologic disturbances thereby acquired could have constituted a basis for a hypersensitivity-like reaction after ingestion of alcohol. Schamberg’s disease induction by vinegar may point to an involvement of acetate, a metabolite of ethanol.

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“…Purpura/petechie around the eyelids are classically seen while performing the Valsalva manoeuvre, but in practice they are more likely after severe coughing or vomiting, and also described after endoscopy [1,2]. The aetiology is a sudden rise in the venous and capillary pressure in the head and neck caused by a rise in intrathoracic pressure during vomiting.…”

Section: Sirmentioning

confidence: 99%