Purpura, Small Vessel Vasculitis, and Vascular Occlusion
Fig. 18.1Purpura. A,B Actinic (solar) purpura. The lesion is flat and solid with a smooth outline. C,D Palpable purpura (raised with a smooth outline). E,F Retiform purpura. The lesions are a flat network of interconnecting rings (“retiform”). Biopsy findings: solar purpura – extravasated erythrocytes (B); palpable purpura – leukocytoclastic vasculitis (D); retiform purpura – vascular occlusion with sparse perivascular inflammation (F).C, Courtesy, Yale Dermatology Residents’ Slide Collection. C, From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.
Palpable Purpura
Palpable purpura (morphology: raised and solid with smooth borders;Fig. 18.1B) is a common manifestation of cutaneous small vessel vasculitis. Causes are diverse and include Henoch–Schönlein purpura (Fig. 18.2A), drug exposure, malignancies (especially hematologic;Fig. 18.2B), systemic disease (Fig. 18.2C–F), and infections. History, other clues on examination (see rheumatoid nodules inFig. 18.2F), and/or laboratory studies are necessary to ascertain the ultimate cause. Other diseases with underlying small vessel damage include acute hemorrhagic edema of infancy (Fig. 18.3A–C), urticarial vasculitis (Fig. 18.3D,E), and erythema elevatum diutinum (Fig. 18.3F,G).
Fig. 18.2Palpable purpura. A Henoch–Schönlein purpura. B Palpable purpura in a patient with myelodysplasia and relapsing polychondritis. C Mixed cryoglobulinemia. D Granulomatosis with polyangiitis (Wegener granulomatosis). E Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). F Rheumatoid arthritis.A,D,F, Courtesy, Yale Dermatology Residents’ Slide Collection; B, Courtesy, Jean L Bolognia, MD. C, Courtesy, Lorinda Chung, MD, Bory Kea, MD and David F Fiorentino, MD. E, Courtesy, Kanade Shinkai, MD and Lindy P Fox, MD. A–C,E,F, From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.
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