Purpura (overview) D65-D69

In a narrower sense, the term purpura refers to an exanthema with petechial skin bleeding (hemorrhages).

Skin hemorrhages (hemorrhages) are a clinical phenomenon in which there are leaks of erythrocytes into the dermal tissue. Skin hemorrhages can be acute or chronic. They are characterized by localized or disseminated, small-spotted or patchy, red, blue, blue-green, or yellow-brown (diascopically not pushable away) spots or palpable elevations (hues due to hemorrhages of different ages). Purpura can be caused by a variety of causes.

A purpura may be flat(spot) or elevated(papule = palpable purpura), inflammatory (vasculitis) or noninflammatory (e.g., due to a vasculopathy).

In a broader sense, independent diseases are also called "purpura", which are associated with hemorrhages in the skin (e.g., purpura pigmentosa progressiva; purpura Schönlein-Henoch).

A distinction is made according to shape and size:

• Petechiae
• Ecchymoses
• Sugillations
• Haematomas
• Vibex (Vibes).

Etiologically, a vascular (vessel wall damage) can be distinguished from a purpura due to coagulation disorders.

1. Cines DB, Blanchette VS (2002) Immune thrombocytopenic purpura. N Engl J Med 346: 995-1008
2. Hundeiker M et al (1977) Dermatological purple forms as early and late allergic reactions. Act Dermatol 3: 39-48
3. Moake JL (2002) Thrombotic microangiopathies. N Engl J Med 347: 589-600