Clinical and Histopathological Study of 84 Cases of Pigmented Purpuric Dermatosis

Lee, Hye Young; Lee, Ji Yeoun; Yoon, Tae Young

Abstract

BACKGROUND
Pigmented purpuric dermatosis (PPD) comprises a group of dermatoses characterized clinically by pinpoint petechiae and purpura with a brown, red, or yellow patchy pigmented base. Histopathologically, extravasation of erythrocytes with hemosiderin deposition, a perivascular lymphocytic infiltrate on the superficial capillaries, and endothelial cell swelling are observed; however, their etiology remains obscure. There have been few reports regarding the clinical and histopathological characteristics of PPD in Korea.
OBJECTIVE
To investigate the epidemiology, etiology, clinical manifestations, and histopathological features of PPD in Korea.
METHODS
We retrospectively evaluated the clinical manifestations and histopathological features of 84 patients with PPD diagnosed at our center between January 2003 and December 2013.
RESULTS
Of the 84 patients, 44 were male and 40 were female. The mean age of occurrence was 44.6 years and, the most commonly involved sites were the lower extremities (95.2%). Most of the PPD patients were asymptomatic (65.5%), however, others complained of itching (25%), pain (3.6%), heat sensations (3.6%), or tingling sensations (2.3%). The majority (63.1%) had Schamberg's disease, 15.5% had Majocchi's disease, 10.7% had eczematid-like purpura of Doucas and Kapetanakis, 7.1% had Gougerot-Blum syndrome, and 3.6% had lichen aureus. Of the 84 patients, 35.7% of patients had medical problems and 32.1% had etiologic factors including orthostatic hypertension (13.2%), trauma (7.2%), contact dermatitis (4.8%), sex hormones (4.8%), postpartum (1.2%), and diltiazem (1.2%). Histopathologically, extravasation of erythrocytes with or without hemosiderin deposit and a mild-to-dense perivascular or lichenoid lymphocytic infiltrate in the upper dermis were common features. A review of the prognoses of 72 patients revealed that 52.8% were clinically improved and that the most common treatment modality was a topical steroid (79.2%).
CONCLUSION
Study results suggested variable clinical manifestations with common histologic features of PPD, and that variable etiologic factors could trigger the occurrence of PPD. We recommend the addition of both trauma and sex hormones as etiologic factors. There was no significant difference between the treatment modalities and the level of clinical improvement.