Chronic venous disease, platelet and haemostatic abnormalities contribute to the pathogenesis of pigmented purpuric dermatoses

Abstract

Background To investigate the aetiology of pigmented purpuric dermatoses (PPD). Methods 63 patients with a provisional diagnosis of PPD were assessed. Skin biopsies were performed to confirm the clinical diagnosis. Haemostasis was assessed using platelet function analyser-100 (PFA-100), light transmission aggregometry (LTA), impedance aggregometry (Multiplate) and measurement of clotting times and clotting factors. Chronic venous disease (CVD) was assessed by duplex ultrasound. When not contraindicated, patients were advised to discontinue haemostatic-modifying drugs or supplements for 4 weeks after which the laboratory measurements were repeated and the clinical resolution of PPD was assessed. Subsequently, a cohort of patients identified with CVD underwent endovenous interventions and further resolution of PPD was assessed. Results CVD was found in 48 patients (76.2%) while haemostatic abnormalities were found in 36 (57.1%). 30 patients (47.6%) had concurrent CVD and haemostatic abnormalities. Modifiable risk factors such as the intake of platelet inhibitors or other drugs and supplements such as fish oil were identified in 53 patients (84.1%). These could be ceased in 35 patients of whom 28 (80.0%) achieved either complete or partial resolution of PPD. Treatment of the underlying CVD was performed in 18 patients resulting in complete or partial resolution in 17 (94.4%). In seven patients (11.1%), no CVD or haemostatic abnormalities were identified, and the risk factors included dietary factors such as excessive caffeine or soft drink consumption. Conclusion Haemostatic abnormalities and CVD contribute to the pathogenesis of PPD. Resolution of PPD in the vast majority of patients may be achieved by cessation of modifiable risk factors and in particular platelet-modifying drugs or supplements and treatment of the underlying venous disease.

Pigmentation of lower limbs: Contribution of haemosiderin and melanin in chronic venous insufficiency and related disorders

“…We did not include patients with pigmented purpuric dermatoses (PPD) given the well understood histological features and pigment composition previously reported by this group. 46 In addition, the dermatopathologist performing the histological analyses was not blinded in regards to the allocation of the sample and whether they were pigmented or control biopsies.…”

Pigmented purpuric dermatosis-ecchymosis and chronic venous disease

“…We have recently read the article published by Parsi et al 1 with great enthusiasm and curiosity. They have investigated the etiology of pigmented purpuric dermotoses (PPD) in lower extremity of 67 patients.…”

Authors Reply: Chronic venous disease, platelet and haemostatic abnormalities contribute to the pathogenesis of pigmented purpuric dermatoses

“…We thank you for drawing our attention the letter of Yetkin et al entitled Pigmented Purpuric Dermatosis-Ecchymosis and Chronic Venous Disease in response to our paper Chronic venous disease, platelet and haemostatic abnormalities contribute to the pathogenesis of pigmented purpuric dermatoses. 1…”

“…We thank you for drawing our attention the letter of Yetkin et al entitled Pigmented Purpuric Dermatosis-Ecchymosis and Chronic Venous Disease in response to our paper Chronic venous disease, platelet and haemostatic abnormalities contribute to the pathogenesis of pigmented purpuric dermatoses. 1 The authors of the letter have erroneously interpreted ecchymosis and purpura to be synonymous with pigmented purpuric dermatosis (PPD, also known as capillaritis). While ecchymosis is the clinical manifestation of an anatomical bleed, PPD is a distinct dermatological condition with a complex aetiology that is vastly distinct from a simple purpura or ecchymosis.…”