Purpura
{{Short description|Skin discoloration due to underlying bleeding}}
{{Other uses}}
{{Infobox medical condition (new)
| name = Purpura
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| image = HSP Vasculitis.jpg
| caption = Petechiae and purpura on the lower limb due to infection-associated vasculitis
| field = Dermatology, hematology
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Purpura ({{IPAc-en|ˈ|p|ɜːr|p|jʊər|ə}}{{cite web |url=https://www.lexico.com/en/definition/purpura |archive-url=https://web.archive.org/web/20191017134333/https://www.lexico.com/en/definition/purpura |url-status=dead |archive-date=October 17, 2019 |title = PURPURA English Definition and Meaning {{!}} Lexico.com}}) is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, or other causes.{{cite web|title=UCSF Purpura Module|url=http://www.dermatology.ucsf.edu/education_training/140.01ClinicalDermatology/Module.8.Purpura%20Module%20REVISED2.pdf|url-status=dead|archive-url=https://web.archive.org/web/20131002064433/http://www.dermatology.ucsf.edu/education_training/140.01ClinicalDermatology/Module.8.Purpura%20Module%20REVISED2.pdf|archive-date=2013-10-02}} They measure 3–10 mm,{{Cite book|title=Clinical Laboratory Hematology|last=McKenzie, Shirlyn B.|others=Williams, Joanne Lynne; Landis-Piwowar, Kristin|year=2014|isbn=978-0133076011|edition=3rd|location=Boston|pages=665|oclc=878098857}} whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.{{Cite book|title=Robbins basic pathology|others=Kumar, Vinay; Abbas, Abul K.; Aster, Jon C.; Perkins, James A.|isbn=978-0323353175|edition=10th|location=Philadelphia, Pennsylvania|pages=101|oclc=960844656|date = 2017-03-28}}
Purpura is common with typhus and can be present with meningitis caused by meningococci or septicaemia. In particular, meningococcus (Neisseria meningitidis), a Gram-negative diplococcus organism, releases endotoxin when it lyses. Endotoxin activates the Hageman factor (clotting factor XII), which causes disseminated intravascular coagulation (DIC). The DIC is what appears as a rash on the affected individual.
Classification
Purpura are a common and nonspecific medical sign; however, the underlying mechanism commonly involves one of:
- Platelet disorders (thrombocytopenic purpura)
- Primary thrombocytopenic purpura
- Secondary thrombocytopenic purpura
- Post-transfusion purpura
- Vascular disorders (nonthrombocytopenic purpura)
- Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged
- Hypertensive states
- Deficient vascular support
- Vasculitis, as in the case of Henoch–Schönlein purpura
- Coagulation disorders
- Disseminated intravascular coagulation (DIC)
- Scurvy (vitamin C deficiency) – defect in collagen synthesis due to lack of hydroxylation of procollagen results in weakened capillary walls and cells
- Meningococcemia
- Clumping fibrillary protein deposits caused by Amyloidosis
- Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities, sometimes needing reconstructive surgery.{{cite journal|title=Toxic Effects of Levamisole in a Cocaine User|journal=New England Journal of Medicine|volume=364|issue=24|pages=e52|publisher=The New England Journal of Medicine|doi=10.1056/NEJMicm1008722|pmid=21675882|year=2011|last1=Muirhead|first1=Trevor T.|last2=Eide|first2=Melody J.}} Levamisole is purportedly a common cutting agent.
- Decomposition of blood vessels including purpura is a symptom of acute radiation poisoning in excess of 2 Grays of radiation exposure. This is an uncommon cause in general, but is commonly seen in victims of nuclear disaster.
Cases of psychogenic purpura are also described in the medical literature,{{cite journal |vauthors=Anderson JE, DeGoff W, McNamara M |title=Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature |journal=Pediatric Emergency Care |volume=15 |issue=1 |pages=47–48 |year=1999 |pmid=10069314 |doi=10.1097/00006565-199902000-00014}} some claimed to be due to "autoerythrocyte sensitization". Other studies{{cite journal |vauthors=Lotti T, Benci M, Sarti MG, Teofoli P, Senesi C, Bonan P, etal |title=Psychogenic purpura with abnormally increased tPA dependent cutaneous fibrinolytic activity |journal=International Journal of Dermatology |volume=32| issue=7 |pages=521–23 |year=1993 |pmid=8340191 |doi=10.1111/j.1365-4362.1993.tb02840.x|s2cid=38433734 }} suggest the local (cutaneous) activity of tissue plasminogen activator can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding. Petechial rash is also characteristic of a rickettsial infection.
Etymology and pronunciation
See also
- Bruise, which is a hematoma caused by trauma
- Purpura secondary to clotting disorders
- Purpura hemorrhagica in horses
- Pigmented purpuric dermatosis
- Schamberg disease (progressive pigmentary purpura)
References
{{Reflist}}
External links
{{Medical resources
| DiseasesDB = 25619
| ICD10 = {{ICD10|D|69||d|65}}
| ICD9 = {{ICD9|287}}
| ICDO =
| OMIM =
| MedlinePlus = 003232
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D011693
}}
- [http://www.aafp.org/afp/20010801/419.html Evaluating the Child with Purpura] {{Webarchive|url=https://web.archive.org/web/20081016080004/http://www.aafp.org/afp/20010801/419.html |date=2008-10-16 }} from American Academy of Family Physicians
{{Bleeding and clotting disorders|us=y}}
{{Authority control}}