Purpura (ICD-10 D69.-) refers to spontaneous, small-spot skin, subcutaneous, or mucosal hemorrhages (= exanthem from hemorrhagic spots). Petechiae are said to occur when the individual efflorescences of purpura are punctate. Other manifestations are:
- Ecchymosis (small areas).
- Sugillation (large area)
- Vibex (striped)
One can distinguish the following forms of purpura:
- Autoerythrocytic purpura (Gardner-Diamond syndrome) – painful skin bleeding, which occurs predominantly in young women.
- Posttransfusional purpura – skin bleeding that occurs after blood transfusion; caused by platelet antibodies.
- Psychogenic purpura
- Purpura anaphylactoides (P. allergica, P. rheumatica) – toxic-allergic skin hemorrhages that occur after infections or but by drugs as well as food.
- Purpura anularis teleangiectodes (Majocchi syndrome) – form of purpura associated with arterial hypertension (high blood pressure), atherosclerosis (arteriosclerosis, arteriosclerosis) and telangiectasias (vascular veins); sporadic occurrence.
- Purpura cerebri – hemorrhage in the brain caused by local capillary damage.
- Purpura cryoglobulinaemia – form of skin hemorrhage caused by cryoglobulinemia.
- Purpura factitia – skin hemorrhages caused by manipulation of the skin.
- Purpura fulminans – patchy to extensive skin hemorrhages (sugillations), e.g. due toinvasive meningococcal infection.
- Purpura fulminans Henoch – highly acute onset and severe form of purpura abdominalis and purpura anaphylactoides.
- Purpura haemorrhagica (idiopathic thrombocytopenia Werlhof, idiopathic thrombocytopenic purpura, ITP; Werlhof’s disease) – disorder of platelet function.
- Purpura haemorrhagica nodularis (Fabry syndrome; Fabry disease; Fabry syndrome; Fabry-Anderson disease) – rare congenital monogenetic metabolic disorder belonging to the group of lysosomal storage diseases (sporadic mutation on chromosome X); Characteristic are blue-red to blackish changes in the skin and mucous membranes (so-called angiokeratomas), paresthesias (tingling and/or numb, burning sensation) in the hands (acroparesthesia) or feet, as well as hearing loss and proteinuria (protein in the urine); hypertension (high blood pressure) and renal insufficiency (kidney weakness).
- Purpura hyperglobulinaemica (Waldenström’s disease) – skin hemorrhages that occur in the context of paraproteinemias (increased occurrence of proteins from cells that multiply uncontrollably).
- Purpura jaune dócre (purpura orthostatica; stasis bleeding).
- Purpura necroticans Sheldon – form of purpura fulminans occurring in infants and young children.
- Purpura pigmentosa progressiva (purpura chronica progressiva, Schamberg’s disease) – form of skin hemorrhage likely caused by drugs or food
- Purpura pulicosa – allergic reaction to flea bites with bleeding and wheals.
- Purpura senilis – form of purpura that usually occurs in older people with actinic (light) damaged skin.
- Purpura thrombasthenica (Glanzmann-Naegeli thrombasthenia) – genetic disease with autosomal recessive inheritance; blood clotting disorder caused by a structural defect in the membrane of platelets (blood platelets); foci may occur in the skin, meninges (meninges), upper respiratory tract, salivary glands, and bone marrow
- Thrombotic thrombocytopenic purpura (TTP; synonym: Moschcowitz syndrome) – acute onset purpura with fever, renal insufficiency (kidney weakness; renal failure), anemia (anemia), and transient neurologic and mental disorders; occurrence largely sporadic, autosomal dominant in the familial form
In most cases, purpura occurs in the lower extremities. Purpura and petechiae can be symptomatic of many diseases (see under “Differential Diagnoses”). Course and prognosis: Course and prognosis depend on the cause. The cause may be, for example, thrombocytopenia (deficiency of platelets) or vasculitis (inflammation of blood vessels). The prognosis depends on the cause, i.e. the underlying disease.
