Updates in the Approach to the Patient with Purpura

Abstract

This review aims to provide an updated clinical framework for how to approach the patient with a purpuric eruption. The approach outlined within is focused on the identification of the primary cutaneous morphology from which one can then generate a focused differential diagnosis and initiate an appropriate workup. The primary morphologies of purpura include petechiae, macular purpura, palpable purpura, and retiform purpura. Each of these morphologies is associated with a specific underlying pathophysiology. Identifying the morphology and pathophysiology that is present is especially important in purpuric eruptions as they may be associated with underlying systemic illness such as malignancy, infection, vasculitis, or autoimmune disease. The approach to purpura starts with identifying the suspected primary cutaneous morphology. This allows the clinician to generate a hypothesis regarding the pathophysiology causing a patient’s eruption. Based on the pathophysiology that is suspected, a differential diagnosis can be generated and an appropriate workup can be initiated. This is especially important in purpuric eruptions as they can be a manifestation of many types of internal diseases.