Overview
Purpura simplex refers to a condition characterized by recurrent skin purpura without other bleeding tendencies, manifested by ecchymosis and petechiae on the skin, especially on the lower extremities, and in a few patients, low-grade fever or arthralgia, which may be associated with estrogens.
Definition
Purpura simplex refers to a condition in which there is only recurrent purpura of the skin without other bleeding tendencies.
Purpura refers to extravasation of red blood cells from capillaries, causing petechiae or ecchymoses on the skin and mucous membranes.
Pathogenesis
There are no definitive epidemiologic data on purpura simplex.
It is most common in young women, and its onset is often associated with the menstrual cycle.
Etiology
Causes
There is no clear etiology for this disease, as it is most common in females and the onset pattern is related to the menstrual cycle, which may be associated with the effect of female hormones on blood vessels and surrounding tissues during menstruation.
Symptoms
Main Symptoms
Symptoms of purpura simplex are limited to petechiae on the skin, and there are no obvious bleeding symptoms in the body (e.g. bleeding gums, nosebleeds, etc.).
Subcutaneous petechiae, ecchymosis
Spontaneous or minor trauma appears subcutaneous petechiae, and subcutaneous petechiae may appear in severe cases.
Predominant site: It can be seen on the skin of the whole body, and is mostly concentrated on the double lower limbs.
Purpura morphology: pinhead-like rash, petechiae and ecchymosis of the size of rice grains to green beans may appear, sometimes slightly elevated on the skin surface, and the color does not fade when pressed.
Taking adrenocorticotropic hormone and drugs affecting platelet function such as non-steroidal anti-inflammatory drugs (aspirin, etc.) can lead to exacerbation of symptoms.
Other symptoms
Low-grade fever, headache, and mild arthralgia may be present in a few patients.
Consultation
Recommendations for consultation
Purpura simplex is diagnosed and treated primarily in hematology.
Prompt medical attention is recommended when there is a large number of petechiae on the skin.
Repeat patients should follow the doctor’s instructions.
Preparation
Registration
Before visiting the outpatient clinic, you need to register at the hospital site or through official channels (hospital’s official website, official app, 114, etc.).
Preparation of information
Prepare your medical documents such as medical card, social security card (health insurance card), etc.
Bring information from previous medical visits, such as medical records.
If you are taking medication, prepare a list of medications.
What questions the doctor may ask
How long have the symptoms of bleeding and petechiae been present? What parts of the body have petechiae?
Have tests been done? What were the results of the tests?
Have you had any treatment? How was it treated? What is the effect of the treatment?
What medications have you taken recently?
Questions you can ask your doctor
Why did you get this disease?
What should I pay attention to during treatment?
Can it be cured?
Will it recur?
Diagnosis
Diagnostic basis
Medical history
May have ecchymosis of the skin associated with the menstrual period.
Exacerbated by administration of adrenal hormones and nonsteroidal anti-inflammatory drugs (e.g., aspirin, etc.).
Clinical manifestations
Symptoms
Petechiae and ecchymoses are seen under the skin, mostly concentrated on both lower limbs.
Physical signs
Positive bundle arm test: the doctor will tie a sphygmomanometer cuff around the patient’s upper arm, inflate and pressurize it, keep the pressure for a period of time and then remove the cuff, raise the forearm up, and observe that there may be a new bleeding spot after resting for a few minutes. More than 10 in women and children, more than 5 in men.
Laboratory Tests
Blood routine
A normal blood test for purpura simplex can rule out purpura due to other blood disorders.
Fasting is not necessary before the test.
Coagulation tests
Partial thromboplastin time, prothrombin time, fibrinogen and other tests are performed to determine the coagulation function.
The coagulation function of purpura simplex is normal, and purpura caused by abnormal coagulation function can be excluded.
Serologic examination
Plasma thrombopoietin, anti-platelet autoantibodies, autoantibody test, Coombs test and other tests can be performed.
There are no abnormal results in purpura simplex, and related immune diseases can be excluded.
Bone marrow image examination
Purpura simplex has no abnormal manifestations, and other hematopoietic system diseases can be excluded.
Differential diagnosis
Purpura simplex should be differentiated from other diseases that can cause purpura.
Vascular diseases
Such as allergic purpura, drug-induced purpura, etc.
Purpura simplex may be related to the menstrual cycle, may be aggravated by NSAIDs, has no obvious etiology, and relevant laboratory tests are helpful in the differential diagnosis.
Coagulation disorders
Thrombocytopenia, intravascular coagulation, hemophilia, etc.
Purpura simplex only has skin bleeding symptoms, without dizziness, fatigue, pallor and other symptoms, relevant blood routine, bone marrow image examination and coagulation function examination can clarify the differential diagnosis.
Skin diseases
Erythema may appear in some skin diseases, such as erythema multiforme, lichen planus, erythema nodosum and so on.
Purpura simplex has no other skin lesions and only petechiae are present. Dermoscopy or tissue biopsy can make a clear differential diagnosis.
Treatment
Principles of treatment: Purpura simplex usually resolves on its own, and there is no risk of excessive bleeding, so treatment is usually not necessary.
Medication
Vitamin C, rutin and carbachol can be taken if necessary.
Precautions: NSAIDs should be avoided in the presence of purpura.
Prognosis
Cure
Purpura simplex usually has a good prognosis.
Hazards
Purpura simplex can cause ecchymosis and petechiae on the skin, which may affect the patient’s image.
Daily
Daily Management
Dietary management
Eat a light diet and choose foods that are easy to digest.
Avoid taking supplements containing estrogen.
Life Management
Avoid strenuous and dangerous exercise.
Protect yourself from bumps and bruises.
Adjust the application of non-steroidal anti-inflammatory drugs (NSAIDs) as prescribed by the doctor during an attack of purpura simplex.
Prevention
The cause of purpura simplex is unknown and there is no effective method of prevention.
Avoid bumping on the limbs as much as possible.
Pay more attention to skin conditions in patients taking NSAIDs.