Arch Argent Pediatr 2017 Apr;115(2):e82-e84

Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

Lichen aureus is a rare pigmented purpuric dermatosis. We present an unusual case because of the pediatric age and the great number of lesions with zosteriform distribution. He is a 10-yearold boy, with a brownish, smaller than 1 cm, sharp edges, lichenified surface, asymptomatic macule, over the inner aspect of the left leg with a zosteriform distribution. Read More

Am J Clin Dermatol 2017 Jun;18(3):383-390

Department of Dermatology, University of Texas McGovern Medical School at Houston, 6655 Travis St, Ste 980, Houston, TX, 77030, USA.

Stasis dermatitis commonly occurs in older age. It is caused by venous hypertension resulting from retrograde flow due to incompetent venous valves, valve destruction, or obstruction of the venous system. Further tissue changes arise from an inflammatory process mediated by metalloproteinases, which are up-regulated by ferric ion from extravasated red blood cells. Read More

J Dtsch Dermatol Ges 2015 Nov;13(11):1073-88; quiz 1089

Division of Environmental Dermatology and Venereology, Department of Dermatology and Venereology, Medical University Graz, Austria.

Similar to all eczematous disorders, irritant and allergic contact dermatitis are primarily defined by their morphology. In addition, the diagnosis of this specific reaction pattern on the skin (and mucous membranes) also requires prior exposure (direct or indirect) to an allergen or irritant. While it is quite easy to give a textbook description of the typical features of eczema, its clinical manifestations in daily practice are diverse and frequently uncharacteristic. Read More

Pediatr Dermatol 2015 Mar-Apr;32(2):291-2. Epub 2015 Jan 30.

Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.

Eczematid-like purpura of Doucas and Kapetanakis is a subtype of the pigmented purpuric dermatoses, a group of uncommon dermatoses of unclear etiology characterized by purpura, petechiae, and hyperpigmentation. The Doucas and Kapetanakis subtype is rare in children, and its subtle findings can initially be overlooked and mistaken for other, more common dermatologic disorders in this age group. We present a case eczematid-like purpura of Doucas and Kapetanakis in an 11-year-old boy initially treated as eczema. Read More

Pan Afr Med J 2015 17;20:144. Epub 2015 Feb 17.

Service de Dermatologie Vénérologie CHU Ibn Sina, Rabat, Maroc.

JAMA Dermatol 2014 Feb;150(2):182-4

Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York.

IMPORTANCE Medications as well as chemical and food exposures have been causally linked to the development of pigmented purpuric dermatosis (PPD). We describe herein what is to our knowledge the first reported case of isotretinoin-induced PPD. OBSERVATIONS A woman in her 30s presented with purpura annularis telangiectodes of Majocchi on the lower extremities 2 months after initiating isotretinoin for the treatment of refractory nodulocystic acne. Read More

Eur J Dermatol 2013 Sep-Oct;23(5):701-2

Department of Dermatology, Kyoto University School of Medicine, 54 Shogoin-Kawara, Sakyo, Kyoto 606-8507, Japan.

Am J Clin Dermatol 2014 Feb;15(1):65-70

Dermatology Clinic, Ataturk Training and Research Hospital, Bilkent way, 3. Street, Ankara, 06800, Turkey,

Background: The relationship between skin diseases and extracutaneous complications in diabetes mellitus (DM) is unclear.

Objective: We aimed to investigate the relationship between skin disorders and diabetic neuropathy, nephropathy, and retinopathy in patients with DM.

Methods: A total of 750 patients with DM were prospectively enrolled. Read More

ISRN Allergy 2013 Sep 15;2013:361746. Epub 2013 Sep 15.

Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Piazza Giulio Cesare 1, 70124 Bari, Italy.

Irritant or allergic contact dermatitis usually presents as an eczematous process, clinically characterized by erythematoedematovesicous lesions with intense itching in the acute phase. Such manifestations become erythematous-scaly as the condition progresses to the subacute phase and papular-hyperkeratotic in the chronic phase. Not infrequently, however, contact dermatitis presents with noneczematous features. Read More

Pol J Pathol 2013 Jun;64(2):157-9; answer 160

Grzegorz Dyduch, Department of Pathomorphology, ul. Grzegórzecka 16, 31-351 Kraków.

We report a pediatric patient with granulomatous variant of pigmented purpuric dermatitis of 8 years duration. Read More

Photodermatol Photoimmunol Photomed 2013 Apr;29(2):97-9

Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Dermatology, Istanbul, Turkey.

Eczematid-like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses (PPDs) with eczematous changes in the purpuric surface. A 10-year-old male and a 44-year-old male patients were admitted to our clinics for itching and flaking of the skin rashes. Based on the clinical and histopathological evaluations, the rashes were identified as eczematid-like PPDs of Doucas and Kapetanakis. Read More

Acta Dermatovenerol Croat 2012 ;20(3):181-6

Polyclinic Department of Dermatology and Venereology, Dubrava University Hospital, Zagreb, Croatia.

Hereditary hemochromatosis (HHC) is a common genetic disorder of iron overload, caused by mutations in the HFE gene. If untreated, abnormal accumulation of iron may lead to organ damage and premature death. Significant changes in the symptomatology of HHC have been observed in recent years, and its full clinical expression is rarely seen. Read More

Acta Derm Venereol 2013 Jan;93(1):95-6

J Cutan Pathol 2011 Dec 7;38(12):979-83. Epub 2011 Sep 7.

Division of Anatomical Pathology, Department of Pathology, Capital District Health Authority (Queen Elizabeth II Site) and Dalhousie University, Halifax, NS, Canada.

The persistent pigmented purpuric dermatitides (PPPD) are a spectrum of dermatologic disorders characterized by petechial and pigmented macules usually confined to the lower limbs. Their etiology is unknown and several clinical variants are recognized. At the microscopic level they are characterized by angiocentric lymphocytic inflammation, red blood cell extravasation and hemosiderin deposition. Read More

J Cutan Pathol 2011 Dec 14;38(12):984-9. Epub 2011 Jul 14.

Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.

The pigmented purpuric dermatoses (PPD) are a group of diseases characterized by petechiae and bronze discoloration of the skin on the lower extremities. Histopathologically, extravasation of erythrocytes with hemosiderin deposition, a perivascular lymphocytic infiltrate centered on the superficial capillaries and endothelial cell swelling are seen. The granulomatous variant of PPD (GPPD) was described in 1996 and only 10 cases have been reported since in the literature, almost exclusively in patients of East Asian descent only involving the extremities. Read More

Can Fam Physician 2010 Oct;56(10):1023, 1024-5

Department of Medicine at the University of British Columbia (UBC) in Vancouver.

Am J Dermatopathol 2009 Feb;31(1):77-80

Department of Dermatology, Wright State University, Dayton, OH 45408, USA.

Pigmented purpuric dermatoses (PPDs) tend to vary clinically, yet share a similar histology. Granulomas are only rarely seen, with 4 prior reported cases, designated granulomatous pigmented purpura. Historically, granulomatous pigmented purpura has been seen in Asians. Read More

Photodermatol Photoimmunol Photomed 2009 Feb;25(1):55-6

Department of Dermatology, Göztepe Training and Research Hospital, Istanbul, Turkey.

Pigmented purpuric dermatoses are a group of dermatoses characterized clinically by pinpoint petechia and purpura on a brown, red or yellow base. Five diseases are included in the group of pigmented purpuric eruptions which significantly overlap clinically and histologically. Phototherapy in various forms of purpuric dermatoses has been reported in literature previously. Read More

Hautarzt 2009 May;60(5):424-7

Klinik für Dermatologie, Venerologie und Allergie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122, Essen, Deutschland.

We report on a case of a bufexamac-induced allergic contact dermatitis with hematogenous dissemination presenting with the clinical and histological picture of a pigmented purpuric eruption. To our knowledge this is the first report on a bufexamac-induced pigmented purpuric dermatosis. It represents a further example of the clinical variety of cutaneous side-effects caused by bufexamac. Read More

Am J Dermatopathol 2008 Apr;30(2):145-9

Division of Pathology, School of Molecular Medical Sciences, Queen's Medical Centre, Nottingham, United Kingdom.

Recently described macular arteritis presents as asymptomatic hyperpigmented macules, runs a chronic, indolent course, and shows lymphocytic arteritis at various stages of evolution ranging from fibrinoid necrosis to endarteritis obliterans. Herein, we present another case that was clinically suspected to be unilateral plantar pompholyx. A 47-year-old male presented with a 2-month history of persistent, reticulated, asymptomatic, nonblanching erythematous and brawny macules, and scattered, slightly scaly papules over the plantar instep of his left foot. Read More

Photodermatol Photoimmunol Photomed 2008 Apr;24(2):95-6

Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.

Pigmented purpuric dermatoses are a group of chronic, recurrent disorders characterized by purpuric lesions mainly involving the lower extremities. Their etiology is unknown. Treatment options are limited and none of them have proven benefit. Read More

Ann Dermatol Venereol 2007 Apr;134(4 Pt 1):378-80

Clinique Dermatologique, Hôpitaux Universitaires, Strasbourg.

Background: Chronic pigmented purpuric dermatitis includes various entities seen above all in adults, although they may occasionally appear in children. The various therapies available are generally unsuccessful. We report the case of a child who responded dramatically to PUVA therapy. Read More

Am J Dermatopathol 2007 Feb;29(1):44-55

Division of Dermatology, Albany Medical College, Albany, NY 12208, USA.

Cutaneous pseudovasculitis represents a heterogeneous collection of disorders that are capable of simulating cutaneous vasculitis and can be broadly classified into diseases that produce hemorrhage (petechiae, purpura, and ecchymoses) or vessel occlusion with resultant livedo, cyanosis, ulcers, digital necrosis, and/or gangrene. Overlap is not uncommon, but if present, one mechanism dominates. Hemorrhagic pseudovasculitis is due to vessel wall dysfunction (incompetence), which can be related to diverse factors that include vessel wall deposition of metabolic substances (amyloid, calcium), nutritional deficiencies (scurvy), nonvasculitic inflammatory purpura (pigmented purpuric dermatitis, arthropod, viral and drug reactions), degeneration of the vessel wall and supporting stroma (senile/solar purpura), direct vessel wall invasion of infective organisms, coagulation-fibrinolytic disorders (eg, thrombocytopenia), and vessel wall trauma. Read More

Pediatr Dermatol 2006 Jul-Aug;23(4):350-4

Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada.

Mycosis fungoides, a cutaneous T-cell lymphoma, typically presents as indolent, progressive, and persistent erythematous patches or plaques with mild scaling and over time can evolve into tumor stage with tumor nodules. Other presentations include eczematous, psoriasiform, poikilodermatous, and hypopigmented patches. We report Mycosis fungoides in a 14-year-old boy presenting as pigmented purpuric dermatitis and review the relevant literature. Read More

Clin Dermatol 2005 Sep-Oct;23(5):465-9

Department of Dermatology and Allergology, University Hospital, Friedrich-Schiller-University Jena, 07743 Jena, Germany.

Hand dermatitis is a common diagnosis seen in dermatologic and general practice. It can present with typical morphology, but uncommon manifestations are possible. This review reports on common and uncommon presentations of irritant and allergic hand dermatitis focusing on uncommon localizations, time course, and morphology such as follicular, pustular, bullous, ulcerous, exudative erythema multiforme-like, purpuric, lichenoid, pigmented, and depigmented skin lesions. Read More

J Am Acad Dermatol 2005 Jul;53(1):168-9

Leuk Lymphoma 2004 Nov;45(11):2321-5

Comprehensive Cancer Center, Our Lady of Mercy Medical Center, New York Medical College, Bronx, NY 10466, USA.

A 65-year-old male developed progressive dry cough and digital clubbing after starting rituximab-CHOP chemotherapy for non-Hodgkin lymphoma. A lung biopsy showed loose non-necrotic granulomas in a background of mild fibrosis and rare eosinophils, compatible with a drug-induced hypersensitivity pneumonia. Associated manifestations of this hypersensitivity reaction were a high eosinophil count, elevated serum levels of immunoglobulin E, and a skin rash consistent with pigmented purpuric dermatitis (Schamberg disease). Read More

J Cutan Pathol 2004 Jan;31(1):26-34

Department of Pathology, Beth Israel Deaconess Medical Center, and Department of Pathology, 330 Brookline Avenue, Boston, MA 02215, USA.

Background: Kaposi's sarcoma (KS) is an angioproliferative lesion that may regress or progress. Progression is related to spindle cell proliferation and the expression of human herpes virus-8 latency genes, including latent nuclear antigen-1 (LNA-1), cyclin-D1, and bcl-2. KS regression has not been well characterized histologically. Read More

Dermatology 2003 ;207(3):331-2

Dermatology 2003 ;207(3):246-7

J Cutan Pathol 2003 Oct;30(9):572-6

Division of Dermatopathology, and Department of Obstetrics and Gynecology, Albany Medical College, Albany, NY 12208, USA.

Background: Lichen aureus is localized variant of persistent pigmented purpuric dermatitis that typically affects the legs and can be associated with delayed hypersensitivity reactions or vascular abnormalities. Plasma cell vulvitis (Zoon's vulvitis) is a rare condition that frequently contains hemosiderin deposits and is suspected to be a mucosal reaction pattern due to variety of insults, most often local irritation or trauma.

Case Report: A 50-year-old female with longstanding complaints of spotting, vulvar dryness, irritation, and dyspareunia presented with circumscribed, purpuric, erythematous vulvar patches. Read More

Dermatology 2002 ;205(2):191-3

Department of Dermatology, University Hospital, Zurich, Switzerland.

Lichenoid pigmented purpuric dermatitis of Gougerot-Blum belongs to a group of closely related disorders which are termed pigmented purpuric dermatoses. It clinically manifests itself with grouped lichenoid papules in association with purpuric lesions. We report a case of lichenoid pigmented purpuric dermatitis of Gougerot-Blum with a heavy band-like CD4-positive lymphocytic infiltrate and clonal rearrangements of the gamma-chain of the T cell receptors as detected by polymerase chain reaction/denaturing gradient gel electrophoresis. Read More

Contact Dermatitis 2002 May;46(5):300-1

Allergology Department, H.G.U.'Gregorio Marañón', Madrid, Spain.

Cutis 2002 Feb;69(2):145-8

Department of Dermatology, Nippon Medical School, Tokyo, Japan.

Lichen aureus is a localized variant of pigmented purpuric dermatitis (PPD) and is rarely reported. A case of lichen aureus in a 28-year-old woman and a 13-year-old boy are presented. Biopsy results revealed the characteristic pattern of lichen aureus, including diffuse deposition of hemosiderin and dermal infiltrate of lymphocytes and histiocytes, some of which had Birbeck granules in the cytoplasm. Read More

Med Electron Microsc 2000 ;33(1):39-43

Department of Dermatology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan.

A case of pigmented purpuric dermatitis (PPD) in a Japanese man aged 59 years is reported with an interesting ultrastructural finding. Clinically, the lesions, which consisted of telangiectatic puncta and pigmentation, were irregular in shape and occurred predominantly on the lower legs without pruritus. Histologically, lymphocytic perivascular infiltrates and extravasation of red blood cells were observed in the papillary dermis. Read More

J Am Acad Dermatol 2001 Sep;45(3):456-8

Department of Environmental Dermatology and Venerology, University of Graz, Austria.

The diagnosis of purpura pigmentosa progressiva in a female patient had to be changed to purpuric contact dermatitis after patch testing with textile dyes. A modified patch test performed in the area in which most of her skin lesions were located revealed a petechial reaction to the azo dye Disperse Blue 124/106. For evaluation of purpura pigmentosa progressiva we suggest a patch test with potential allergens, and, especially for textile dyes, a patch test at the lesion site may be helpful. Read More

Contact Dermatitis 2000 Dec;43(6):360

Ward 29, Aberdeen Royal Infirmary, Foresterhill, UK.

J Am Acad Dermatol 2000 Aug;43(2 Pt 1):308-10

Departments of Dermatology and Pathology, Massachusetts General Hospital, Boston, USA.

Pigmented purpuric eruptions are characterized clinically by purpura, most commonly petechial, and brownish pigmentation. Although there are several idiopathic variants, several drugs have been associated with these eruptions. We present a patient who experienced pigmented purpura on her lower extremities several months after initiating medroxyprogesterone acetate injection. Read More

J Am Acad Dermatol 1999 Nov;41(5 Pt 2):827-9

University of Cincinnati, College of Medicine, Department of Dermatology, Ohio 45267-0523, USA.

Pigmented purpuric dermatosis can occasionally be caused by various medications. No reported cases of oral hypoglycemic agents causing pigmented purpuric dermatosis exist. We report a case of glipizide-induced pigmented dermatosis. Read More

Ann Dermatol Venereol 1999 Apr;126(4):321-6

Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg.

Introduction: A few cases of patients with both purpuric pigmented dermatitis and cutaneous lymphoma have been reported. The aim of this study was to evaluate the prognosis of purpuric pigmented dermatitis.

Material And Methods: This is a monocentric retrospective study at the dermatology department of the university hospital of Strasbourg. Read More

J Dermatol 1998 Nov;25(11):756-8

Department of Dermatology, Hanyang University College of Medicine, Seoul, South Korea.

A 23-year-old man had recurrent erythematous purpuric patches in a transverse-linear arrangement on his back and arms. One week prior to a recent episode, he took acetaminophen for 3 days. Four months earlier, he developed the same purpuric lesions at/around the same anatomical site when he took acetaminophen for pain-relief. Read More

Am J Dermatopathol 1997 Apr;19(2):108-18

Department of Dermatology, University of California, San Francisco 94143-0506, USA.

Mycosis fungoides (MF) can present with purpuric lesions, and rare patients who seemed to have persistent pigmented purpuric dermatitis (PPPD) have developed MF. We recently encountered two patients referred to our cutaneous lymphoma clinic who had PPPD rather than MF and two others who appeared to have both conditions, leading us to explore the histologic similarities of these diseases. We examined specimens from 56 patients with PPPD to determine the frequency of MF-like histologic configurations, namely, the psoriasiform lichenoid, psoriasiform spongiotic lichenoid, and atrophic lichenoid patterns. Read More

Ann Dermatol Venereol 1997 ;124(8):544-6

Clinique Dematologique, Hôpitaux Universitaires de Strasbourg.

Background: Mycosis fungoides can mimic pigmented purpuric dermatitis. We report such a case which progressed to peripheral T-cell lymphoma; progression was revealed by reactive hemophagocytic syndrome (RHS).

Case Report: A 65-year old male patient was hospitalized for a pigmented and purpuric eruption. Read More

J Am Acad Dermatol 1994 Jan;30(1):145

Oral Surg Oral Med Oral Pathol 1992 Dec;74(6):780-2

Centre for the Study of Oral Disease, University of Bristol Dental Hospital and School.

The pigmented purpuric dermatoses are a group of disorders in which there is chronic capillaritis, with pigmented purpuric lesions predominantly on the lower limbs. We report a case with chronic oral lesions that had histologic features most in keeping with the purpuric lichenoid dermatitis of Gougerot and Blum syndrome. Read More

J Am Acad Dermatol 1992 Nov;27(5 Pt 1):778-80

Department of Dermatology, Albert Szent-Györgyi Medical University, Szeged, Hungary.

J Cutan Pathol 1992 Oct;19(5):366-70

Skin and Cancer Foundation, Sydney, Australia.

Mast cell numbers were quantitated in adult cases of mastocytosis demonstrating non-diffuse perivascular and upper dermal concentrations of mast cells. Using the Leder stain and computerised video image analysis, a mean of 382 (+/- 28 SE) mast cell per mm2 were counted in the superficial dermis in skin biopsies from 30 adult cases of mastocytosis, in contrast to a mean of 43 (+/- 5 SE) mast cells per mm2 in skin biopsies from 50 inflammatory dermatoses represented by subacute dermatitis, pigmented purpuric dermatosis, erythema multiforme, lichen planus and granuloma annulare. Ten skin biopsies showing no significant inflammation had a mean of 54 (+/- 7 SE) mast cells per mm2 in the upper dermis. Read More

Allerg Immunol (Paris) 1992 Sep;24(7):256-61

Faculté de Médecine, Universitaire de Strasbourg, France.

For etiologic checking of cutaneous vasculitis, skin testing may be of valuable help: epicutaneous patch-tests with delayed lecture (48 h.) performed with contact haptens (rubber allergens, azo dyes, resins .. Read More

J Am Acad Dermatol 1992 Feb;26(2 Pt 1):203-6

Department of Dermatology, Cleveland Clinic Foundation, OH 44195-5031.

Background: Although a linear IgM dermatosis of pregnancy has been reported, other authors have not found evidence for a distinct linear IgM dermatosis.

Objective: We set out to determine whether or not continuous dermoepidermal junction IgM deposition detected by direct immunofluorescence was indicative of a specific disease.

Methods: We collected nine cases during a 9-year period in which biopsy specimens for direct immunofluorescence revealed continuous linear IgM at the dermoepidermal junction in the absence of other immunoglobulins. Read More

J Am Acad Dermatol 1991 Oct;25(4):642-7

Department of Dermatology, Mayo Clinic, Rochester, MN 55905.

Purpura simplex manifests clinically as macular purpuric and petechial pigmented, golden, annular, or lichenoid lesions. These subtypes have been termed Schamberg's purpura, lichen aureus, Majocchi's purpura, and Gougerot-Blum purpura. Histologically, there is inflammation and hemorrhage without fibrinoid necrosis of vessels. Read More