Differential Diagnosis
1: Senile Purpura
Characteristics using clinical terminologies
Senile Purpura denotes RBC (red blood cell) extravasation into the mucous membrane or skin. Thus, purpuric lesions don’t blanch upon pressing with a finger or glass slide (diascopy). The condition has a broad differential diagnosis which may be easily narrowed down through classification on the basis of morphology, and other lab and clinical findings (Soutor & Hordinsky, 2013). Associated clinical terminologies and differential diagnosis include:
Petechiae: These are flat lesions, not more than 4mm-dimension macules, usually bright red at first. They subsequently fade and acquire a rusty color.
Ecchymosis: Also flat lesions, >5mm patches or macules, usually purple or red at first. They subsequently fade and acquire a green, yellow, or brown color.
Palpable purpura: Oval or round, elevated, occasionally hardly noticeable, purple or red plaques or papules.
Retiform purpura: Branching or stellate lesions having geometric or angular borders, occurring both as non-palpable patches and clear plaques (Soutor & Hordinsky, 2013).
Explore different conditions that could be the cause of the skin abnormality
Senile Purpura (blood spots, purpura senilis, and skin hemorrhages): This condition widely occurs among aged individuals with a tendency of developing bruises, particularly on their legs and forearms. The bruises aren’t caused by mineral and vitamins deficiencies or bleeding disorders. Aged individuals’ skin and skin blood vessels become fragile and thin, causing bruises which initially have a purplish red color. Large purpura are termed ecchymoses while extremely small purpura spots are termed petechiae (PHC, 2018).
Causes:
Allergic vasculitic purpura
HSP (Henoch-Schönlein purpura) represents one such commonly occurring condition caused by blood vessel wall infiltration and swelling as the anaphylactic response to various chemical and physical stimuli (such as infections). ?-haemolytic streptococcal infection-triggered upper respiratory tract infections typically precede it. It may occur as an epidemic among children, characterized by a fever and a slightly-raised purpuric rash (Saulsbury, 2010), normally affecting the buttocks and the front of the legs. Acute arthritis, nephritis with proteinuria and gastrointestinal pain may occur in association. The rash can continue forming over many weeks, with major, severe complications including bleeding in the central nervous system, acute injury of the kidney or acute intussusception. It is generally self-limiting though potentially responsive to steroids. Cochrane review failed to produce any evidence of benefits of short prednisolone courses in acute kidney illness…
Bibliography
Crookston K et al (2010). Acquired bleeding disorders. Amyloidosis, PathologyOutlines.com.
Hahn D, Hodson EM, Willis NS, et al, (2015). Interventions for preventing and treating kidney disease in Henoch-Schonlein Purpura (HSP). Cochrane Database Syst Rev. Doi: 10.1002/14651858.CD005128.pub3.
Imm, N. (2015). Purpuric Rashes. Patient Platform Limited.
PHC. (2018). Senile Purpura. Prime Health Channel.
Saulsbury, FT (2010). Henoch-Schonlein purpura. Curr Opin Rheumatol. 598-602
Shtalrid M, Shvidel L, Vorst E, et al, (2006). Post-transfusion purpura: a challenging diagnosis. Isr Med Assoc J. 672-4.
Soutor, C., & Hordinsky, M. (2013). Clinical Dermatology. New York: McGraw Hill Professional.
Yamada K, Sakurai Y, Shibata M, et al, (2009). Factitious purpura in a 10-year-old girl. Pediatr Dermatol. 597-600.
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