The pathological spectrum and clinical correlation of pigmented purpuric dermatosis—A retrospective review of 107 cases

Abstract

This study described the wide pathological spectrum of pigmented purpuric dermatosis among Asians. Physicians should be aware about the clinical and pathological variations to facilitate diagnosis.

Vasculitis

“…In a recent retrospective review of 107 Asian cases, five histopathologic patterns were observed: lichenoid (42%), perivascular (37%), interface (10%), spongiotic (7%), and granulomatous (4%). Of interest, lymphocytic vasculitis was noted in 16% of cases [116]. Schamberg, eczematoid, and lichen aureus clinical variants correlate with perivascular, spongiotic, and lichenoid histopathologic patterns [116].…”

“…Of interest, lymphocytic vasculitis was noted in 16% of cases [116]. Schamberg, eczematoid, and lichen aureus clinical variants correlate with perivascular, spongiotic, and lichenoid histopathologic patterns [116].…”

Brownish asymptomatic lesions on the arms and legs

“…However, differentiating MF from inflammatory dermatoses can be difficult in some cases [2,3]. Pigmented purpuric dermatosis (PPD) encompasses a group of cutaneous diseases that feature petechial and/or purpuric lesions [4], usually involving the legs. The disease can have several clinical subtypes [5] and may be related to various systemic diseases such as lupus erythematosus, lymphoid malignancies and rheumatoid arthritis [4,6,7], as well as medications such as ACE inhibitors, beta-blockers, antidepressants and calcium channel blockers [8].…”

“…In such circumstances, clinical involvement confined to the legs, presence of a CD8+ infiltrate shown with immunohistochemistry, as well as polyclonal TCR rearrangement can be helpful. However, some cases with a monoclonal TCR rearrangement have been described in the literature [4,6,7], as well as cases with partial loss of pan-T cell markers and CD4 expression [7]. The above-mentioned cases are commonly observed in patients with drug-related PPD [7].…”

“…Moreover, an increasing number of experts believe that PPD can be regarded as a form of T cell dyscrasia encompassing the spectrum of cutaneous T cell lymphoma. Due to the presence of lesions on the arms as well as the legs, differential diagnosis ruled out Schamberg disease (SD) and lichen aureus (LA) [4,5]. Indeed, both diseases involve the legs and show purpuric patches with "cayenne pepper" puncta (SD) or single localized golden macules on an extremity (LA) [4,5].…”