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Actinic Purpura
What is Actinic Purpura?
Damage to dermal blood vessels from long-time sun exposure
results in fragility. Minor trauma, often unrecalled, results in vessel
damage and extravasation of blood into the dermis, most frequently on the dorsum
of the hands and forearms. This manifests as large (>3 mm) purpuric macules with
a regular border, termed ecchymoses. It is a common, often incidental
finding in elderly patients.
With what can it be confused?
Actinic purpura should be differentiated from other causes of
blood vessel fragility that can result in ecchymoses. The most common of
these is long-term corticosteroid use, wither topical or systemic, leading to
skin atrophy and fragility. Amyloidosis, a systemic disease in which
"amyloid" proteins are deposited in blood vessels and other locations, can
result in papules and nodules that bleed easily, and a tendency to easy bruising
(purpura) even in the absence of obvious amyloid deposits. The rare
genetic disorder Ehler-Danlos syndrome is characterized by skin
hyperelasticity, increased skin fragility, and joint hyperextendability.
Vasculitis is palpable and not macular.
(Also see: Purpura)
How is it diagnosed?
Actinic purpura is a clinical diagnosis. Biopsy is not
necessary.
How is it treated?
There is no treatment for actinic purpura; it is only of
cosmetic concern. However, it is also a marker for long-term sun damage.
Patient's should be counseled on the use of sunscreen, protective clothing, and
sun avoidance.
What is the prognosis?
Ecchymoses resolve slowly, leaving brown macules behind.
New ones form as a result of minor trauma, as there is no cure for the
underlying vascular fragility. Scarring may sometimes result.
Date created 04/14/2007
Last updated
01/03/2009
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