A Rare Presentation of Self-Resolving Purple Fingers

Abstract

Achenbach syndrome is a rare, benign, self-limiting, syndrome of unknown etiology. Here, we report a 66-year-old female who presented to the dermatology clinic with waxing and waning non-palpable purpura for the last year on the volar aspect of her hands bilaterally. The patient admitted to tingling prior to the onset of the purpura and mild tenderness following presentation. The purpura would spontaneously resolve without discoloration or scarring after 2-7 days. The patient stated these episodes can occur anywhere from a few times a month to every 1-2 months. Evaluation and work-up performed by her primary care physician and rheumatologist did not reveal an explanation for her symptoms. Two punch biopsies were performed and revealed a perivascular lymphocytic infiltrate with extravasted erythrocytes and pigmented macrophages consistent with a pigmented purpuric dermatosis. Immunofluorescence was negative. The diagnosis of Achenbach syndrome was made by diagnosis of exclusion. Reassurance was provided to the patient and she was given DerMend Bruise formula cream, which contains retinol, glycolic acid, arnica oil, ceramides, niacinamide, and phytonadione, to monitor for improvement of her symptoms. It is important for healthcare providers to be aware of the benign nature of this syndrome to be able to provide reassurance to patients and avoid an unnecessary, more invasive evaluation.