Pigmented Purpuric Dermatosis Research Articles

Pigmented purpuric dermatosis: A dermoscopic and management perspective

Pigmented purpuric dermatosis: A dermoscopic and management perspective

Pigmented Purpuric Dermatoses in Children: A case Report & Importance of Clinicopathological Correlation

Abstract Introduction/Objective Pigmented purpuric dermatoses are characterized by chronic but benign cutaneous eruptions featuring petechiae, purpura, or yellow to brown patches. It is more common in adult males and adolescents is generally localized on the lower limbs and has been reported in children multiple times. Our objective is to bring to consideration that it is not very uncommon in children and clinicopathological correlation is very important for a confirmed diagnosis. Methods/Case Report In our study, we report a case of 9 years 9-year-old girl with asymptomatic brown patches on lower legs bilaterally but asymmetrically since > 6-8 months. Histopathology was suggestive of typical features suggestive of PPD, including dilated blood vessels, endothelial cell swelling, hemosiderin deposition, red cell extravasation, and perivascular lymphocytic-macrophage infiltration. Pediatric instances of PPD are infrequently documented, due to their exclusion from the other differential diagnosis of purpura, post-inflammatory hyperpigmentation, and atopic dermatitis in this age group. Because these conditions lack systemic findings and share similar clinical presentations with other skin disorders, they may be overlooked or mistaken for more common conditions in pediatric patients. Histopathology plays a vital role in case of patches of persistent pigmentation on the skin especially lower limbs to rule out PPD. In many cases of pediatric PPD, it is usually considered self-resolving, but there is complete resolution has also been reported with Vitamin C, rutoside, narrow-band ultraviolet B treatment, and topical corticosteroids. Results (if a Case Study enter NA) In many cases of pediatric Pigmented purpuric dermatosis is usually considered as self-resolving, but there is complete resolution has also been reported with Vitamin C, rutoside [3] narrow-band ultraviolet B treatment and topical corticosteroids. Conclusion Our study aims to emphasize improving diagnostic accuracy, especially in pediatric cases, enhancing outcomes, and understanding the necessity of histopathological diagnosis in pediatric PPD cases. We also seek to abate the risk of misdiagnosis or underdiagnosis, and the need for increased awareness of this diagnosis in pediatric cases so that we can counsel and manage patients and their families accordingly. Through a comprehensive review of existing literature, we advocate for the inclusion of Schamberg’s type purpura as a differential diagnosis for purpuric eruptions or cutaneous discoloration in childhood.

Response to upadacitinib monotherapy in a patient with eczematid-like pigmented purpuric dermatosis

Response to upadacitinib monotherapy in a patient with eczematid-like pigmented purpuric dermatosis

From legs to abdomen: Navigating the uncharted territory of pigmented purpuric dermatosis in a middle-aged female.

From legs to abdomen: Navigating the uncharted territory of pigmented purpuric dermatosis in a middle-aged female.

Clinicoepidemiologic Characteristics and Prevalence of Venous Insufficiency in Patients with Pigmented Purpuric Dermatosis

Clinicoepidemiologic Characteristics and Prevalence of Venous Insufficiency in Patients with Pigmented Purpuric Dermatosis

Therapeutic Approach in Pigmented Purpuric Dermatoses-A Scoping Review.

Pigmented purpuric dermatoses (PPD) encompass a group of chronic skin conditions characterized by the presence of petechiae, purpura, and pigmentation changes. While generally benign, these dermatoses can be persistent and aesthetically bothersome. Key clinical features include red to brownish patches with a distinctive "cayenne pepper" appearance, predominantly localized on the lower extremities, particularly the shins. Subtypes include Schamberg disease, Majocchi's disease, Gougerot-Blum disease, Ducas and Kapetanakis pigmented purpura, and lichen aureus. Diagnosis relies primarily on clinical evaluation of skin lesions, with biopsy as a confirmatory tool. Although the exact cause of PPD remains unclear, capillary fragility and red blood cell extravasation are implicated. Treatment strategies for PPD aim to alleviate symptoms, considering the generally benign and chronic nature of the condition. As there is no standardized treatment, various methods with varying efficacy are employed. After searching SCOPUS and PubMed databases, we assessed 42 original articles to present current knowledge regarding therapy of PPD. This review will compare treatment approaches specifically in Schamberg disease and other manifestations of pigmented purpuric dermatoses.

P01 Pigmented and purpuric patches in sun protected areas of a 9 year old child

Abstract Pigmented purpuric dermatosis-like mycosis fungoides (PPD-like MF) is a rare variant of paediatric mycosis fungoides (MF). Clinically, it can be challenging to diagnose and differentiate from pigmented purpuric dermatosis (PPD). Usually, has an indolent course if diagnosed in the early stage. The lesions often localize to sun-protected areas with three stages: patch, plaque, and tumour. Clinical features alone are insufficient for diagnosis and a skin biopsy is mandatory.1 We report a nine year old boy who presented with a three year history of a persistent, slowly progressing, mildly pruritic and scaling rash on the right buttock and medial thighs bilaterally. He was otherwise well with no other relevant medical or family history of note. The physical examination revealed erythematous to purpuric, mild scaly patches with confluent involvement on the right buttock extending to less defined involvement of the both inner thighs. The body surface area involved was less than <10%. No other clinical findings on examination. A punch biopsy for haematoxylin and eosin (H&E) staining was consistent with mycosis fungoides. T cell receptor gene rearrangement testing detected a monoclonal T-cell population. A diagnosis of pigmented purpuric dermatosis-like mycosis fungoides was made. The patient responded well to a potent topical steroid (mometasone furoate) daily which was gradually tapered to twice weekly/intermittent usage to maintain response.

Pigmented purpuric dermatoses: A review

Pigmented purpuric dermatosis (PPD) comprises a group of skin conditions characterized by flat, nonpalpable petechiae and purpura as a result of capillaritis. Although the precise cause of PPD is as yet unknown, increased vascular permeability and capillary fragility are key factors in its pathophysiology. PPD has diverse clinical presentations, but the histopathology of all these variants essentially remains the same. The initial purpuric lesions develop a golden-brown hue owing to hemosiderin absorption and eventually progress to chronic pigmentary changes. These lesions, which often affect the lower limbs, are either asymptomatic or accompanied by moderate pruritus, and can be difficult to diagnose and treat. There are several subtypes of clinical presentations that have been documented over the years. In order to accurately diagnose PPD, a thorough clinical evaluation and, occasionally, a biopsy may be required. It is essential to identify the condition and reassure patients of its benign nature. Treatment is usually necessary due to the chronic nature of the condition, its consequences on physical and mental well-being, and the presence of significant lesions or itching. In this review, we outline the various prevalent PPDs and discuss their etiopathogenesis, clinical features, and diagnostic and treatment modalities.

Overlap of histological features of pigmented purpuric dermatosis and kaposi sarcoma – pseudo kaposi sarcoma

Pseudokaposi sarcoma can be congenital or acquired. Due to prolonged venous stasis, leads to peripheral tissue hypoxemia, which results in neovascularisation and fibroblast proliferation. Treatment includes rectification of the underlying pathology such as graded compression stockings or compression pumps for venous stasis and ulcer management with regular wound care. Medical management includes oral antibiotics, along with compression therapy with good results. Our patient presented mild lower limb pitting edema unilaterally with erythematous barely elevated plaque over the anterior aspect of the lower limb.

A Rare Presentation of Self-Resolving Purple Fingers

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.

A retrospective study on the direct immunofluorescence findings in pigmented purpuric dermatosis.

Pigmented purpuric dermatosis (PPD) is characterized by grouped petechiae, purpuric macules, and pigmentation in the bilateral lower extremities. It runs a chronic and relapsing course. Pathophysiology is poorly understood, but it has been proposed to be an immune-complex disease or capillaritis. This study aimed to determine the incidence and patterns of positive direct immunofluorescence (DIF) findings in patients with clinically and histopathologically confirmed PPD. The association between DIF deposition type and clinical profile was also analyzed. Patients with a clinical and histopathologic PPD diagnosis who had undergone DIF studies at a tertiary medical center with attached dermatopathology and immunofluorescence diagnostic centers between January 2002 and December 2021 were included in this study. Data on age, sex, disease duration, comorbidities, and drug intake were collected from medical records. There were 65 patients who satisfied the inclusion criteria. Among them, 58 (89%) had at least one positive finding and 53 (82%) were vascular deposition of immunoglobulin (Ig), complement, or fibrinogen. The most common vascular deposition was fibrinogen (71%) followed by C3 (62%), IgM (18%), IgA (6%), and IgG (3%). Fibrinogen deposition was associated with hypertension (p < 0.03). There was no association between vascular DIF deposition of IgG, IgA, and C3, with age, sex, comorbidities, disease duration, and drug history. The most common DIF findings in PPD were vascular deposition of fibrinogen and C3, with or without Ig presence. DIF findings supported a vascular origin in PPD but not an immune complex-mediated disease. Hypertension was associated with fibrinogen deposition and may play a role in its pathophysiology.

Pigmenting Purpuric Dermatoses: Striking But Not a Manifestation of COVID-19 Infection.

Purpuric or erythematous eruptions of the lower extremities can be perplexing, especially because this clinical sign has been associated with COVID-19 infection. Since the start of the pandemic, COVID-19 often has been the first differential diagnosis for many clinical findings; however, pigmented purpuric dermatoses (PPDs) are distinctive, reassuring, eponymous, and not linked to this virus. In this article, we differentiate the PPDs and delineate them from potentially serious differential diagnoses, including inflammatory retiform purpura, leukocytoclastic vasculitis, stasis dermatitis, and cellulitis.

The debut of Schamberg disease (a clinical case)

A group of pigmented purpuric dermatoses includes a list of skin diseases characterized by multiple petechial hemorrhages, purpura, and increased skin pigmentation (yellow, brown, or red patchy). Schamberg disease is the most common representative of this group with a benign, chronic and recurrent course of idiopathic origin. The lesions are often asymptomatic or associated with mild pruritus, usually occurring on the lower extremities. The diagnosis is not a dilemma, as it is made based on clinical examinations and identification of the classical rash morphology, but is also emphasizing the role of a wide range of specialists in the evaluation and treatment of this pathological condition. The aim of the study. To analyze a clinical case of the debut of Schamberg disease. Results. Considering the sporadic nature and rarity of the disease, the clinical case of Schamberg disease diagnosed in a 53-year-old man who visited a pediatrician concerning his child’s illness is presented. The probable cause of the disease debut was a complex trigger effect (a long-term use of diclofenac sodium, drinking alcohol on the eve). Conclusions. The report is aimed at drawing attention to Schamberg disease (Schamberg purpura) as a diagnostic and therapeutic challenge not only for general practitioners, internal medicine specialists but also for dermatologists, phlebologists, hematologists in particular.

Clinico Epidemiological Study and Dermoscopic Findings of Pigmented Purpuric Dermatosis.

Clinico Epidemiological Study and Dermoscopic Findings of Pigmented Purpuric Dermatosis.

Clinical analysis of skin lesions in livedoid vasculopathy: a study of 46 Chinese patients.

Clinical data regarding cutaneous manifestations in Chinese patients with livedoid vasculopathy (LV) are limited. To assess clinical features of skin lesions in LV, especially the characteristics of extensive livedo reticularis and pigmented purpuric dermatosis-like lesions in these patients. This was a single-center retrospective study of 46 Chinese patients with LV between March 2021 and July 2021. The characteristics of skin lesions in LV were described in detail. A total of 29 females and 17 males were included in this study, with a mean age of 27.7 years (ranging from 13 to 51 years). Twenty (43.5%) patients developed their first skin lesions before age 18. Among 46 patients, 33 presented livedo reticularis with 78.8% (n=26) of these patients whose livedo reticularis was extensive. Seven patients had lesions simulating pigmented purpuric dermatosis, including four cases of pigmented purpura and three cases of telangiectatic purpura. Numbness was found in 16 patients, mainly in the lower limbs (62.5%), ankles (31.3%), and dorsum of the feet (18.8%). For patients with symptoms of extensive livedo reticularis, retiform purpura, or numbness, it is necessary to make a differential diagnosis.

Progressive pigmented purpuric dermatosis in skin of color: a dermoscopic and histopathological correlation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Progressive pigmented purpuric dermatosis (PPPD) is a chronic cutaneous presents with petechiae, purpura on hyperpigmented yellowish-brown macules or patches. Diagnosis is straight forward, sometimes may be challenging for the diagnosis. Dermoscopy is a non-invasive tool. It gives characteristic patterns in PPPD. However, dermoscopic descriptions in skin of color are limited to case reports. Here, dermoscopic evaluation in skin of color is studied in detail. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a cross sectional observation study. Ethical clearance and written consent was obtained. Patients of skin type 4 and 5, attending dermatology clinic with suspected lesions of PPPD were selected serially. Handheld dermoscope was used for examination. Site for dermoscopic examination was considered as target area. Skin biopsy was taken. Dermoscopic patterns were analysed and features were correlated with histopathological changes.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Totally 30 patients with 27 males and 3 females were enrolled. Schamberg’s disease was commonest type noted in 21patients. Eczematoid, lichen aureus, and lichenoid types were seen in 2 (6.7%) each. Hence, overall occurrence of Schamberg’s disease was statistically significant (p=0.028). Commonest dermoscopic findings were brown pigment network and yellowish-brown dots/globules. Least common features included linear vessels and bluish globules. Distorted pigment network noted in 29 (96.7%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Dermoscopy of PPPD shows characteristic patterns of which pigment network, red globules and yellowish-brown globules are the basic features. These features correlate well with histopathological changes. Yellowish-brown globules and background are prominently observed in skin of color. Larger studies are recommended to validate these differences.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Progressive ascending telangiectasias

Progressive ascending telangiectasias

Development of Schamberg's disease after SARS‐CoV‐2 vaccination

Schamberg's disease is one of a group of pigmented purpura diseases. We report a 43-year-old woman, who developed Schamberg’s disease after SARS-CoV-2 vaccination. Three days after vaccination, a purpuric eruption occurred on the lower extremities, extending to the buttocks, and subsided in 4 weeks. No recurrence was observed thereafter. It is suggested that the vaccination triggered the development of the eruption, which was not merely coincidental. SARS-CoV-2 vaccination may stimulate a certain population of T cells, resulting in the development of pigmented purpuric dermatoses.

TNF-\u03b1 inhibitor induced pigmented purpuric dermatoses: a case report

BackgroundWe present a rare case of TNF-α inhibitor induced pigmented purpuric dermatoses (PPD) and explore its mechanisms and management.Case presentationA 44-year-old woman presented with non-pruritic non-tender petechial rash on bilateral lower limbs after being started on Adalimumab, with the rash progressing to worsen on Golimumab, both used for managing her seronegative peripheral arthritis. Laboratory panel revealed a negative vasculitis screen and skin biopsy confirmed the condition. After ceasing the TNF-α inhibitors and changing to Secukinumab, an Interleukin-17 inhibitor, the lesions stopped erupting and slowly resolved.ConclusionPPD is a benign skin condition and has been associated with various medications and exposure to chemicals in the literature. Different mechanisms have been proposed in the literature however its exact aetiology is unknown. To date, there is no standardized treatment however patients should be reassured that PPD is benign and will often regress by itself once the causative agent has been removed.

All that reddens is not psoriasis: a peculiar localization of pigmented purpuric dermatosis in two psoriatic patients.

article: All that reddens is not psoriasis: a peculiar localization of pigmented purpuric dermatosis in two psoriatic patients - Italian Journal of Dermatology and Venereology 2022 August;157(4):376-7 - Minerva Medica - Journals