Purpura: What You Need to Know

Date: Jul-18-2016 Purpura occurs when small blood vessels bleed into surrounding tissue. They appear as small purple spots just beneath the skin's surface.

Purpura can point to a range of medical problems, ranging from minor injuries to life-threatening infections.

Contents of this article:

What is purpura?

Symptoms and complications

Causes, risk factors, and prevention

Tests and diagnosis

Treatments for purpura

What is purpura?

The purple spots of purpura are typically between 4 to 10 millimeters in diameter. Some people develop larger patches of 1 centimeter or greater. These are called ecchymoses.

Purpura rashes are defined by the amount of platelets in the patient's blood.

Purpura tends to occur in clusters that may be found in a single area or cover a large portion of the body. The larger the rash is, the greater the bleeding will often be.

Unlike some other rashes, purpura will not change color when pressed. The rash can look a lot like tiny clusters of bruises, but the skin should not be itchy or irritated. Skin problems suggest a cause other than purpura.

Purpura itself is a symptom. To determine the cause, doctors must run a range of tests. These tests will assess the patient's nutrition, platelet levels, inflammation, potential for infection, and blood vessel health.

Treatment for purpura usually requires treating the rash's underlying cause.

Types of purpura

Doctors break purpura rashes into two categories based on platelet counts. Platelets are cell fragments that help blood clot more effectively, preventing dangerous bleeding.

Thrombocytopenic purpuras occur when platelet counts are low, suggesting an underlying clotting disorder. Non-thrombocytopenic purpuras mean platelet levels are normal, suggesting another cause.

A range of underlying medical conditions can cause both kinds of purpura.

One of the best-studied varieties of purpura is Henoch-Schönlein purpura. More common among young children, this variety of purpura is frequently preceded by a respiratory infection. Symptoms often go away on their own, but some people with Henoch-Schönlein purpura suffer dangerous inflammation that leads to kidney problems.

Idiopathic thrombocytopenic purpura (ITP) is a form of purpura with an unknown cause. Patients with ITP experience platelet destruction in the bloodstream. This leaves them more at risk of the bleeding that creates purpura's typical rash.

Symptoms of purpura

The main symptom of purpura is a purplish-red rash just beneath the skin's surface. The rash can appear anywhere on the body, including on mucous membranes such as the throat. The symptoms that sometimes accompany purpura can help identify its cause.

Patients who experience purpura with any of the following symptoms should seek medical treatment:

Low platelet count, which may lead to increased bleeding after an injury, bleeding gums or nose, or blood in urine or bowel movements

Sore, swollen joints, particularly in the ankles and knees

Gut problems such as nausea, vomiting, diarrhea, or stomach pain

Kidney problems, particularly protein or blood in the urine

Tiredness

Complications of purpura

Because purpura can signal an underlying medical problem, it may lead to complications if left untreated. When purpura is the result of a blood clotting disorder, the untreated disorder can cause life-threatening bleeding. Quick diagnosis and treatment of the underlying cause can reduce a patient's risk of serious complications.

Kidney damage can occur in people experiencing Henoch-Schönlein purpura. This damage may require dialysis or a kidney transplant, and can become life-threatening if left untreated.

Henoch-Schönlein purpura may also cause a rare condition in which the bowel folds over itself. This creates a bowel obstruction that restricts digestion. Bowel obstructions can be fatal if left untreated.

ITP occasionally causes bleeding in the brain. This can cause permanent brain damage or death if not promptly treated.

Causes of purpura

To treat purpura, doctors must determine its cause. Purpura that does not lower platelet levels has a range of causes and risk factors:

A lack of vitamin C could lead to purpura.

Disorders and infections present from birth that cause abnormalities in blood vessels or blood production, such as Ehlers-Danlos syndrome and rubella

Amyloidosis, which causes amyloid plaques to build up in the body

Blood vessel deterioration associated with age

A lack of vitamin C, also known as scurvy

Infectious or inflammatory diseases that affect the blood vessels

Some drugs, such as steroids and sulfonamides

Purpura with a lowered platelet count has a number of potential causes:

Diseases that impair bone marrow function may restrict the body's ability to make platelets. Leukemia, aplastic anemia, myeloma, and bone marrow tumors can all attack bone marrow.

Drugs that reduce platelet count can lead to clotting problems that produce purpura rashes.

ITP occurs when the body attacks its own platelets, increasing the risk of bleeding and purpura rashes. In newborns whose mothers have ITP, reduced platelet count can also lead to purpura.

Severe infections may lower platelet count by consuming them.

Risk factors and prevention of purpura

Purpura itself is not a disease but a symptom of another problem. The only effective method for preventing purpura is avoiding the conditions that cause it. As most of these conditions are not due to lifestyle factors, there may be little a person can do to stop the risk of purpura.

Risk factors for purpura include:

Blood clotting issues caused by medication or disease

Infectious diseases, particularly among children and the elderly

Poor nutrition when it leads to a lack of vitamin C

Some forms of cancer, such as leukemia and myeloma

Inflammatory conditions and disorders, such as Ehlers-Danlos syndrome

Advanced age

Poor blood vessel health

Diagnosing purpura

The purple spots of purpura are fairly easy to tell apart from other rashes. Purpura is not normally accompanied by itching or other common skin issues. Finding the underlying cause of purpura can be tricky, however.

Doctors often ask questions such as:

A skin doctor should be able to diagnose purpura with a physical examination.

Do you have any other symptoms?

Does anyone else in the home have the same symptoms?

How long have you had the rash for?

Have you had this rash before?

Do you take any medications?

Are there any other medical problems?

A number of routine tests, beginning with a complete blood count (CBC) blood test, help investigate the cause of purpura. A CBC will reveal whether the patient has low platelets and whether any underlying infections are occurring.

If the doctor suspects ITP, they may order bone marrow testing. A skin biopsy can also provide important information, particularly when a doctor is unable to find an underlying cause for the purpura.

Some forms of skin cancer can mimic the purple spots of purpura. A biopsy can rule out skin cancer.

If a doctor suspects Henoch-Schönlein purpura, urine tests can assess kidney functioning by testing for protein and blood in the urine.

Doctors may also perform other tests based on the patient's symptoms and the suspected diagnosis.

Treatments for purpura

Not all cases of purpura demand immediate treatment. Doctors often opt to watch the patient for other symptoms to see if they go away on their own. Children experiencing Henoch-Schönlein purpura are often likely to get better without treatment.

When treatment is necessary, it is due not to the rash itself. Treatment is needed for causes such as leukemia, or effects such as kidney failure.

Treatment for Henoch-Schönlein purpura

Treatment for Henoch-Schönlein purpura focuses on improving the symptoms. Doctors may recommend non-steroidal anti-inflammatory drugs (NSAIDS) to reduce inflammation and pain. Steroid treatment can reduce kidney damage and abdominal pain. If kidney damage is severe, doctors may prescribe drugs to suppress the immune system.

Treatment for ITP

ITP symptoms range from mild to severe, and some patients require no treatment at all. Those who do may benefit from drugs designed to boost platelet count, or removal of the spleen. Lifestyle treatments can also help since drugs such as aspirin and warfarin can damage platelets.

Drugs that suppress the immune system such as prednisone may help elevate platelet levels. In patients who suffer platelet counts that are low enough to be life threatening, doctors may offer immune globulin treatment.

Treatment for other forms of purpura

Treatment for other forms of purpura centers around tackling the underlying cause. This can include options such as chemotherapy, antiviral drugs, steroid medications, antibiotics, and surgery.

When purpura is caused by a medical condition that cannot be cured, ongoing checking of platelet levels and organ functioning may be necessary.

Written by Zawn Villenes

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.