Dermoscopic Findings and the Clinicopathologic Correlation of Pigmented Purpuric Dermatosis: A Retrospective Review of 60 Cases

Abstract

Background Pigmented purpuric dermatosis (PPD) is known as a chronic recurrent eruption which usually presents with petechiae and pigmented macules on the lower extremities. Dermoscopy is a noninvasive diagnostic tool in identifying pigmented and vascular lesions, which can also be beneficial in the evaluation of PPD. Objective We aimed to analyze the common dermoscopic characteristics of PPD, and correlate those findings with the histopathologic features. Additionally, dermoscopic and pathological findings in this study population were compared with other similar studies from the literature review. Methods A retrospective analysis was performed using data of 60 patients who were diagnosed as PPD by skin biopsy and had dermoscopic examination. The pathologic analysis was performed by categorizing the pattern into lichenoid, perivascular, interface, and spongiotic subtype, and the dermoscopic assessment was performed by the three authors independently. Results In dermoscopy, 96.7% of the patients showed red globules and dots, followed by brownish patch, coppery-red pigmentation, and annular comma-like vessels. The pathologic pattern analysis revealed statistically significant association of lichenoid pattern with coppery red pigmentation, perivascular pattern with annular/comma-like vessels, and spongiosis pattern with reticular pigmented network and linear vessels. The interrater similarity test showed total kappa value of 0.811 which referred to “very good”. Conclusion In this study, the prevalence of dermoscopic features in Asian PPD patients was identified, which was similar with previous studies. The dermoscopic-pathologic correlation was found in four dermoscopic features. We suggest that dermoscopic examination is helpful in clinical diagnosis and pathological prediction of PPD.

Dermoscopic feature analysis of different skin lesions in Langerhans cell histiocytosis

“…Dark‐brown pigmentation in the superficial dermis could be seen in the histopathological examination, and although there was no definite evidence for this, it may be due to haemosiderin deposition after the red blood cells are absorbed. In some previous studies, 7 red spots, globules and patches corresponded to extravascular red blood cells, while brown spots and globules corresponded to dermal endophagocytic haemosiderin cells at different stages of pigmented purpura dermatosis, which is consistent with our findings.…”

“…These structures are often seen in lichen sclerosis 6 and pigmented purpuric dermatosis. 7 In the current study, histopathological examination of LCH in all 15 patients showed varying amounts of extravasation of red blood cells in the superficial dermis, which was highly consistent with the purplishred globules or patches seen under dermoscopy.…”

“…Under histopathology, the purplish‐red globules or patches appeared to be patches of bleeding, corresponding to the extravasation of red blood cells in the superficial dermis. These structures are often seen in lichen sclerosis 6 and pigmented purpuric dermatosis 7 . In the current study, histopathological examination of LCH in all 15 patients showed varying amounts of extravasation of red blood cells in the superficial dermis, which was highly consistent with the purplish‐red globules or patches seen under dermoscopy.…”

Utility of dermoscopy in cutaneous small vessel vasculitis: Preliminary observations from a study of 30 cases

“…Being inflammatory purpura,[ 9 ] PPDs are probably the main differential diagnosis for CSVV. Comparing our findings with the established dermoscopic features of PPDs,[ 10 - 13 ] we noted the following,…”

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

“…3 Dermoscopy in PPPD is well documented and coppery red pigmentation and red globules are the commonest findings dermoscopically in large majority of the studies. 5,7,8 In this study, brown pigment network and yellowishbrown globules were present in all 30 patients. These findings were similar to the previous reports and compounds that these patterns are highly characteristic of PPPD.…”