Two Cases of Unilateral Pigmented Purpuric Dermatosis

Abstract

Two cases of pigmented purpuric dermatosis showing unusual distribution are reported. Case 1: 35-year-old female. A group of three asymptomatic purpuric macules developed on the ulnar side of the elbow flexure of the left forear 3-6 months before presentation. Histopathological analysis revealed a band-like inflammatory infiltrate in the Uppermost dermis and extravasation of red blood cells just beneath the epidermis, but there was no evidence of lichefaction degeneration in the basal layer of the epidermis. Case 2: 26-year-old female. Asymptomatic purpuric pigmentations developed on the flexure side of the right lower extremity in a linear arrangement 2-3 months before presentation. Histopathological analysis revealed focally perivascular inflammatatory infiltrates consisting mainly of lymphocytes and conspicuous extravasation of red blood cells into the papillary dermis. There was no histological evidence of vasculitis in either case. Hemosiderin deposits were more limited than expected in both patients. Both cases are compatible with diagnoses of pigmented purpuric dermatosis. Case 1 on the left arm was compatible with lichen purpuricus. Case 2 occurred in a linear arrangement on the right leg and had a history of aspirin use for chronic headache. We therefore suspected that medication had been an etiological or contributing factor.

The remarkable paradigm of segmental (mosaic) drug eruptions

“…'s case adds up to already reported, yet exceptional instances of drug eruptions occurring in a mosaic form, which include, beside FDE,[13–5] lichenoid dermatitis,[6–10] spongiotic dermatitis[11–14] and pigmented purpuric dermatosis [Table 1]. [1516] Segmental lesions were distributed along with Blashko lines in all cases. The superimposed segmental pattern was – somehow surprisingly – frequent (33.3% vs. the 66.7% of the isolated segmental one).…”

Pigmented purpuric dermatoses: An overview

“…The etiology is unknown 1,3 . Venous hypertension, 3 exercise 5 and gravitational dependency, 1,3 capillary fragility, 5 focal infections 4 and chemical ingestion 1,3,4 are important cofactors that appear to influence disease presentation. Drugs are the most frequently reported provocating factors, especially in Schambergs’ disease 5,7–9 and are listed in Table 2.…”

“…5), and is different from other PPDs, though the clinical differences between them are minor. Itching purpura of Lowenthal 1,4 is considered to be a more symptomatic variant of Schambergs’ disease. Granulomatous variant of PPD was reported by Saito et al.…”

Dermatoscopic findings of pigmented purpuric dermatosis

“…Venous hypertension, exercise , gravitational dependency, capillary fragility, focal infections, and chemical ingestion are important cofactors. 2,4 Specific drugs are suspected to induce PPD, including: acetaminophen, aspirin, adalin, carbromal, chlordiazepoxide, glipizide, glybuzole, hydralazine, meprobamate, persantin, reserpine, thiamine, interferon alpha, and medroxyprogesterone acetate injection. 2 The differential diagnosis of PPD includes hyperglobulinaemic purpura, early mycosis fungoides, purpuric clothing dermatitis, stasis pigmentation, scurvy, leukocytoclastic vasculitis, and drug hypersensitivity reactions.…”