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Purple

Key concepts

The purpura is a lesion similar to the hematoma, a consequence of the rupture of capillaries below the surface of the skin. Petechial purpura (hematoma diameter <3 mm) can be distinguished from ecchymotic purpura (lesion diameter between 1 and 2 cm).

Purple: causes and classification

Purple may or may not be related to thrombocytopenia.

  1. Thrombocytopenic purpura: may be caused by megaloblastic anemia, liver cirrhosis, leukemia, myeloma, idiopathic thrombocytopenic purpura, anticoagulant therapy, blood transfusion
  2. Non-thrombocytopenic purpura: it can be caused by amyloidosis, micro-vascular damage, hemangioma, severe infections, hypertension, vasculitis, steroid therapy
  3. Purple dependent on other coagulation disorders: disseminated intravascular coagulation, meningococcal meningitis , scurvy, splenomegaly
  4. Psychogenic purpura: dependent on emotional conditions

Purple: diagnosis

The diagnosis is clinical and based on the medical observation of the lesions. An additional diagnostic test is performed by biopsy.

Purple: therapies

Treatment for purpura depends on the triggering cause

Purple: definition

"Porpora" is a general term referring to every condition characterized by small spots on skin, organs and mucous membranes, including the lining of the mouth. The purple is the immediate consequence of the rupture of small blood vessels (capillaries), located below the surface of the skin: more simply, the purple is a small subcutaneous hematoma.

The purple derives from the Latin term purpura, which means violet: the spots that appear on the skin due to traumas or disorders of the coagulation capacity of the blood, in fact, have a purple or burgundy color, and do not discolor with acupressure.

Classification

Purple can be classified on the basis of two important elements:

  1. Hematoma size
  2. Causes

Let's go step by step:

What types of purples can be identified based on their size?

  • The small hematomas of purpura (properly so called) have dimensions between 0.3 and 1 centimeter.
  • The petecchiale purple (or simply petechiae) is characterized by small lesions, with a diameter of less than 3 millimeters.
  • The ecchymotic purpura (or ecchymosis) precisely identifies more consistent lesions, with a diameter greater than 10 mm but less than 20 mm. Sometimes, ecchymotic purpura is hardly distinguishable from the actual hematoma (which, by definition, extends beyond 2 cm in size).

What variations of purpura exist based on the triggering cause?

Often the purpura is caused by alterations in the platelet count. Individuals with thrombocytopenia are therefore at risk of developing small or large hematomas on the surface of the skin or in internal cavities.

Let us briefly recall that we speak of thrombocytopenia when the thrombocyte count (or platelets, if you prefer) falls below 150, 000 units per cubic meter.

Platelets, as we know, are very important constituents of the blood, which play a leading role in the regulation of hemostasis and in maintaining the integrity of the vessel coating. When the number of platelets falls below the standard range, the regulation of coagulation capacity is lost.

Thus we distinguish two groups of purple:

  1. Thrombocytopenic purpura : purpura is the expression of a more or less marked reduction in the number of platelets circulating in the blood.

    The causes that reside in the appearance of this type of purpura clearly depend on what triggered the thrombocytopenia:

    • MEGALOBLASTIC ANEMIA
    • Taking drugs that prevent the formation of platelets (ANTICOAGULANT THERAPY)
    • HEPATIC CIRRHOSIS: the number of platelets is reduced due to their destruction, induced by the pathology
    • LEUKEMIA: the reduction in the platelet count that characterizes this severe tumor form predisposes the patient to ecchymoses, purpura, petechiae and hematomas.
    • MYELOMA: a blood neoplasm in which we witness the uncontrolled production of cells of the immune system, used for the synthesis of antibodies.
    • IDIOPATIC THROMBOCYTOPENIC PURPLE: this is an autoimmune disease that is distinguished by the destruction of thrombocytes by auto-antibodies. Among the most frequent consequences, the appearance of red spots on the skin (purple) stands out. Autoimmune neonatal thrombocytopenia is a coagulation disorder typical of children born to an ITP-affected mother (autoimmune thrombocytopenia)
    • BLOOD TRANSFUSION: there is a thrombocytopenia due to dilution
  1. NON-thrombocytopenic purpura : the cause of purpura is not identifiable in the reduction of the platelet count. This variant of purpura is a consequence of vascular disorders, such as:
    • AMYLOIDOSIS: disease characterized by the abnormal deposition of low molecular weight proteins in the extracellular site. The appearance of red spots on the skin (purpura, petechiae, ecchymosis) is a characteristic symptom of amylodosis.
    • MICRO-VASCULAR DAMAGES, typical of the elderly: the advanced age makes the capillaries more fragile, therefore the non-thrombocytopenic purpura is very frequent in the elderly. This form of purpura assumes the connotation of actinic purpura, solar purpura or senile purpura.
    • CONNECTIVE DISORDERS: lupus erythematosus and rheumatoid arthritis
    • EMANGIOMA: this is an abnormal accumulation of blood vessels in the skin or internal organs. It is precisely a tumoral form in which blood vessels proliferate in the endothelium.
    • Severe INFECTIONS: even serious infections can predispose the victim to the appearance of small red spots on the skin, including purple. The most frequent infections are: smallpox, varicella, measles, Parvovirus B19 infections (fifth disease), cytomegalovirus infections, rubella and meningitis.
    • HYPERTENSION: classic example are the pressure variations that occur during childbirth. Such a condition can favor the appearance of purpura in the parturient.
    • VASCULITIS (inflammation of blood vessels): vasculitis is responsible for Henoch-Schönlein purpura (or anaphylactoid purpura). This variant of purpura is characterized by the accumulation of IgA, immunocomplexes originating from exposure to drugs, infectious agents or foods involved in airway infections.
    • Therapy with STEROID DRUGS: taking corticosteroids for long periods can cause the manifestation of purpura, especially in the hands, arms and thighs. Steroid-dependent purpura is caused by the atrophy of the collagen fibers that support blood vessels. The clinical manifestations of steroid purpura are comparable to those of senile purpura.

An exaggerated consumption of saffron can cause even serious toxic effects: among these, the bleeding induced by the reduction in the number of platelets (eg purple) stands out

  1. Purple dependent on coagulation alteration : in addition to thrombocytopenia, other coagulation disorders predispose to purpura.
    • Disseminated intravascular coagulation (typical consumption coagulopathy): it is a very dangerous disease characterized by the presence of thrombi (or clots) in blood vessels. The abnormal and uncontrolled production of clots slowly consumes the coagulation factors; consequently, the blood has a low propensity to coagulate, therefore triggers haemorrhagic phenomena (purpura and more serious lesions).
    • Meningococcal meningitis ( Neisseria meningitidis )
    • Scurvy (a serious deficiency of vitamin C): the walls of the blood capillaries are fragile and weakened, therefore the affected patient manifests petechiae, purpura and ecchymoses throughout the body.
    • Splenomegaly: the volumetric increase in the spleen can alter the coagulation capacity of the blood, sequester platelets and favor the formation of red spots on the skin (purple).
  2. Psychogenic purpura: according to some Authors, there is also a psychogenic form of purpura. Under certain conditions, the typical red specks of purple tend to be accentuated in response to emotional conditions of stress, tension or anxiety. Psychogenic purpura occurs more frequently in middle-aged women with a particularly unstable personality, predisposed to epitaxis or other hemorrhages. Psychogenic purpura is best described in the literature with the term " Gardner-Diamond purple ".

Diagnosis and therapies

The diagnosis for purpura is essentially clinical, so it is based on direct medical observation of the lesions. Eventually, for a diagnostic assessment, it is possible to undergo a skin biopsy. Treatment for purpura depends on the triggering cause:

  • Antibiotics are recommended for bacterial infections
  • Antiviral drugs are indicated for the treatment of virus-dependent purpura
  • Scurvy-dependent purpura should be treated by taking vitamin C
  • Patients predisposed to so-called psychogenic purpura should take relaxation courses or take antidepressant / anxiolytic drugs (subject to medical prescription)
  • For purpura dependent on a severe reduction in platelets: read the article on drugs for the treatment of thrombocytopenia
  • For the purpura caused by the increased volume of the spleen: read the article on drugs for the treatment of splenomegaly

Patients with alterations in blood coagulation capacity should avoid the administration of intramuscular drugs, and prefer the intravenous route; in doing so, the risk of developing ecchymoses, purpura, petechiae and hematomas is minimized.

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