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Purpura

Purpura are purple-colored spots that are seen on the skin, mucous membranes, and other organs.

Purpura: Causes, Diagnosis, Treatment, and Pictures

Purpura

Purpura refers to purple-colored spots that are usually seen on the skin, including mucous membranes and other organs. It is also called skin hemorrhages or blood spots.

Purpura is usually recognized when there is pooling of blood under the skin due to ruptured small blood vessels. The size of the purple-colored spots often ranges from small spots to large patches. Purpura is usually benign. However, in some cases, having purpura spots may also indicate serious medical conditions, such as bleeding and clotting disorders.

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People with thrombocytopenia or low platelet levels are more prone to excessive bleeding and bruising. Platelets are cells that help the body form clots to stop bleeding. Thrombocytopenia could be an inherited condition, but it could also be due to any of the following factors:

Classification

Purpura is classified depending on its appearance or cause.

1. Platelet Disorders

  • Primary (Idiopathic) Thrombocytopenic Purpura: This condition is due to autoimmune or unknown reasons, and can affect both children and adults.
  • Secondary Thrombocytopenic Purpura: This condition is often caused by internal or external factors, such as systemic diseases, infections, or drugs. 

2. Coagulation Disorders

  • Disseminated Intravascular Coagulation (DIC): This condition may vary from relatively mild to severe or rapidly fatal disorder (purpura fulminans).
  • Warfarin-Induced Skin Necrosis (WISN): This condition is a rare complication of oral anticoagulant therapy.
  • Heparin-Induced­ Thrombocytopenia (HIT): In this condition, thrombocytopenia is caused by the administration of an anticoagulant called heparin. 

3. Vascular Disorders

Vascular disorders are caused by problems with the arteries and veins. These problems include:

  • Non-thrombocytopenic purpura
  • Small blood vessel damage
  • Increased intraluminar pressure
  • Sun-damaged skin or senile purpura (poor vascular support)

Consult your doctor if you notice any unusual growths or changes in your skin. 

Diagnosis

To diagnose purpura, your doctor will first examine your skin. The doctor may also ask you regarding your personal and family medical history. A blood sample may also be taken to check your platelet count and other abnormalities. Aside from blood tests, a skin biopsy may also be performed. These diagnostic tests can help identify the cause of your purpura and help your doctor determine the best treatment for your condition. 

Both children and adults can develop purpura. Most cases in children occur after a viral infection, and usually go away without any treatment. Thrombocytopenic purpura in most children also tends to resolve on its own within several months after the onset of the disorder.

However, most cases of purpura in adults are chronic, which needs treatment to keep platelet counts within normal range and help manage the symptoms.  

Treatment

Treatment for purpura usually depends on what’s causing it. Most people with mild thrombocytopenic purpura tend to recover without any treatment. However, if the disorder that’s causing your purpura doesn’t go away on its own, treatment is usually needed.

Treatment may include certain medications, splenectomy or the surgical removal of the spleen, and cessation of medications that affect platelet function, such as blood thinners, aspirin, and ibuprofen. 

Corticosteroids

Corticosteroid medications can help increase platelet counts by decreasing immune system activity. The platelet count may return to its normal level after 2-6 weeks. Your doctor will tell you to stop taking your medications when your platelet count is within normal limits. 

It is very important to talk to your healthcare provider regarding the risks of long-term corticosteroid use, which include weight gain, bone loss, and cataracts. 

Intravenous Immunoglobulin

If purpura is due to severe bleeding, intravenous immunoglobulin (IVIG) may be given. Before surgery, IVIG may also be administered to rapidly increase the platelet count. Although this treatment is effective when it comes to elevating platelet counts, its effects are usually short-term, and can cause certain side effects, such as fever, nausea, and headache. 

Other Therapies

Promacta (eltrombopag) and Nplate (romiplostim) are the latest medications used for the treatment of low platelet count in people who have chronic idiopathic thrombocytopenic purpura (ITP). These drugs enable the bone marrow to have an increased production of platelets to reduce the risk of bleeding and bruising. However, the use of these medications may also cause any of the following side effects:

Rituxan (rituximab) is a drug used for the treatment of patients with severe thrombocytopenic purpura and those who don't respond to corticosteroid therapy. This medication may also cause side effects, such as fever, rash, low blood pressure, and a sore throat. 

Splenectomy

Spleen removal may be recommended by your doctor if medications aren't working for the treatment of thrombocytopenic purpura. The spleen is the organ responsible for the elimination of platelets, so removing it can help increase your platelet count. However, a splenectomy may not be effective for everyone as surgery also comes with certain risks, such as infections. 

Transfusion of platelet concentrates, immunoglobulin, and corticosteroids may also be performed in emergency cases or when purpura causes severe bleeding. 

Outlook

The outlook for purpura usually depends on what's causing it. Once you have a confirmed diagnosis, your doctor will discuss treatment options, including the long-term effects and outlook for your condition. 

Untreated thrombocytopenic purpura may cause excessive bleeding in certain areas of the body. When there is excessive bleeding in the brain, fatal brain hemorrhage can take place. Mild cases in people who start immediate treatment usually make a complete recovery. However, in severe cases, people can have chronic purpura, especially when treatment is delayed. Consult your healthcare provider as soon as you suspect purpura. 

Sometimes, certain activities and medications can make purpura worse, and may not completely go away. For this reason, the use of drugs that can decrease platelet count (aspirin and ibuprofen) and high-impact activities, which increase your risk of bruising, injuries, and bleeding, should be avoided. 

References

Purpura. (April 2017). https://medlineplus.gov/ency/article/003232.htm

Thomas, A., et. al. Purpuric and petechial rashes in adults and children: initial assessment. BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1285.

Purpura. (November 2015). https://www.dermnetnz.org/topics/purpura/

Leung AK, et. al. (2001). Evaluating the child with purpura. Am Fam Physician. 2001 Aug 1;64(3):419-28.