Clinical and Laboratory Findings of Pigmented Purpuric Dermatoses

Abstract

BackgroundPigmented purpuric dermatoses (PPD) are chronic, recurrent group of disorders characterized by petechial and pigmentary macules usually localized on the lower limbs. Its etiopathogenesis is unknown. There are very few clinical and etiological studies on PPD in the literature.ObjectiveWe aim to examine the etiopathogenetic factors of PPD retrospectively.MethodsDemographic characteristics, history of co-morbid disorders and drug usage, hepatitis markers, levels of serum lipids, findings of Doppler ultrasonography in lower extremities, and patch test results of the 24 patients of PPD were examined retrospectively. The patch test results, history of drug use, and co-morbid disorders of the patients were compared with those of the control groups.ResultsThe male-to-female ratio was 1 : 2, and 83.3% of the patients had Schamberg disease. Seventeen patients had co-morbid disorders and 16 used various drugs, but there was no statistically significant difference between the controls and patients. One patient was positive for hepatitis B surface antigen and 1, for anti-hepatitis C virus antibody. Nine had elevated total cholesterol levels, and 5 had elevated triglyceride levels. Further, 30% of them were positive for at least 1 allergen, while 16% of the control subjects were positive for at least 1 allergen, but statistically significant difference was not found between the 2 groups. Variable degrees of venous insufficiency were detected in 75% of the patients on Doppler ultrasonography of the lower extremities.ConclusionVenous insufficiency and hypercholesterolemia might be the basic predisposing factors for PPD. Further studies are needed to show if diabetes mellitus and hypertension may cause perivascular inflammation in PPD.

Dermatoscopic findings of pigmented purpuric dermatosis

“…7 In our study, the proportion of males was slightly higher than that of women - 17 men (53%) and 15 women (47%).…”

“…2,3 It is divided into five clinical types: SD accounts for more than half of all PPD cases, while eczematid-like purpura of Doucas and Kapetanakis, lichen aureus, Majocchi's disease, and pigmented purpuric lichenoid dermatosis are seen in 10%, 10%, 5%, and 5% of cases, respectively. 6,7 In our study, SD accounted for 93% of the cases. This is higher than reported but similar to the results of Gönül et al (83.3%), another Turkish study.…”

“…This is higher than reported but similar to the results of Gönül et al (83.3%), another Turkish study. 7 Genetic and geographic differences may affect the clinical types, while other types may not be considered or diagnosed as PPD at primary care clinics.…”

“…It has been reported that venous hypertension, exercise, gravitational dependency, capillary fragility, focal infections, and alcohol ingestion are important factors in PPD. 1,2,7,10 Some case series have analysed the granulomatous variant of PPD associated with hyperlipidaemia. 7,10,11 In one study, 42.9% of the patients had hypercholesterolaemia, 23.8% had hypertriglyceridaemia, and 62% had increased LDL.…”

“…1,2,7,10 Some case series have analysed the granulomatous variant of PPD associated with hyperlipidaemia. 7,10,11 In one study, 42.9% of the patients had hypercholesterolaemia, 23.8% had hypertriglyceridaemia, and 62% had increased LDL. 7 In our study, LDL levels were increased in 17 patients (61%), hypertriglyceridemia was seen in 10 (43%), while hypercholesterolaemia was seen in 12 (44%).…”