Skip to main content
SpringerLink
Log in

Purpura and Microvascular Occlusion

  • Living reference work entry
  • First Online:
Atlas of Dermatology, Dermatopathology and Venereology

  • 66 Accesses

Abstract

Purpuric lesions can be induced by thrombocytopenia, thrombocytosis, and platelet defects, or can be a manifestation of pigmented purpuric dermatoses. Microvascular occlusion in the skin may have distinctively patterned lesions, such as retiform purpura; it is clinically important to recognize and distinguish them from cutaneous vasculitis (due to inflammatory occlusive destruction of the vessels) in order to determine associated conditions and prescribe appropriate therapies. In this chapter, purpura, purpuric dermatoses, and most important microvascular occlusive disorders are described.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Aladdin Y, Hamadeh M, Butcher K (2008) The Sneddon syndrome. Arch Neural 65(6):834–835

    Article  Google Scholar 

  • Amiral J, Bridey F, Wolf M, Boyer-Neumann C, Fressinaud E, Vissac AM, Peynaud-Debayle E, Dreyfus M, Meyer D (1995) Antibodies to macromolecular platelet factor 4-heparin complexes in heparin-induced thrombocytopenia: a study of 44 cases. Thromb Haemost 73(1):21–28

    Article  CAS  Google Scholar 

  • Avci G, Akoz T, Gul AE (2009) Cutaneous cholesterol embolization. J Dermatol Case Rep 3(2):27–29

    Article  Google Scholar 

  • Balestra B, Quadri P, Dermarmels Biasiutti F, Furlan M, Lämmle B (1994) Low molecular weight heparin-induced thrombocytopenia and skin necrosis distant from injection sites. Eur J Haematol 53(1):61–63

    Article  CAS  Google Scholar 

  • Ballard JO (1999) Anticoagulant-induced thrombosis. JAMA 282(4):310–312

    Article  CAS  Google Scholar 

  • Burns T, Breathnach S, Cox N, Griffiths C (2016) Urticarial vasculitis. In: Rook’s textbook of dermatology, 9th edn. Oxford Blackwell Science, Oxford, UK, pp 101.21–101.22

    Google Scholar 

  • Carrozza P, Gabutti L, Gilliet F, Marone C (1997) Heparin-induced systemic inflammatory response syndrome with progressive skin necrosis in haemodialysis. Nephrol Dial Transplant 12(11):2424–2427

    Article  CAS  Google Scholar 

  • Carvajal D, Quiroz C, Morales C, Fernández J (2019) Granulomatous pigmented purpuric dermatosis: report of a Latin-American case with blaschkoid distribution. An Bras Dermatol 94(5):582–585

    Article  Google Scholar 

  • Chan YC, Valenti D, Mansfield AO, Stansby G (2000) Warfarin induced skin necrosis. Br J Surg 87(3):266–272

    Article  CAS  Google Scholar 

  • Cox NH, Piette WW (2004) Purpura and microvascular occlusion. In: Burns T, Breathnach S, Cox NH, Griffiths C (eds) Rook’s textbook of dermatology, 7th edn. Blackwell, Turin

    Google Scholar 

  • Donohue KG, Saap L, Falanga V (2003) Cholesterol crystal embolization: an atherosclerotic disease with frequent and varied cutaneous manifestations. J Eur Acad Dermatol Venereol 17(5):504–511

    Article  CAS  Google Scholar 

  • Greinacher A, Lubenow N (2003) Heparin-induced thrombocytopenia. In: Arnout J, de Gaetano G, Hoylaerts M, Peerlinck K, van Van Geet C, Verhaeghe R (eds) Thrombosis: fundamental and clinical aspects. Leuven University Press, Leuven

    Google Scholar 

  • Greinacher A, Völpel H, Janssens U, Hach-Wunderle V, Kemkes-Matthes B, Eichler P, Mueller-Velten HG, Pötzsch B (1999) Recombinant hirudin (lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia: a prospective study. Circulation 99(1):73–80

    Article  CAS  Google Scholar 

  • Hazan C, Fangman B, Cohen D (2007) Lichen aureus. Dermatol Online J 13(1):23

    PubMed  Google Scholar 

  • Hu P, Mao Z, Liu C, Hu X, Kang H, Zhou F (2018) Malignant atrophic papulosis with motor aphasia and intestinal perforation: a case report and review of published works. J Dermatol 45(6):723–726

    Article  Google Scholar 

  • Karadag AS, Bilgili SG, Onder S, Calka O (2013) Two cases of eczematid-like purpura of Doucas and Kapetanakis responsive to narrow band ultraviolet B treatment. Photodermatol Photoimmunol Photomed 29(2):97–99

    Article  Google Scholar 

  • Kaur I, Chowdhry S, D’Souza P (2019) Dermoscopy of lichen aureus. Indian Dermatol Online J 10(5):615–616

    Article  Google Scholar 

  • Khan Z, Watson DK (2000) Heparin-induced skin necrosis. BJOG 107(10):1315–1316

    Article  CAS  Google Scholar 

  • Kim H, Zhen DB, Lieske JC, McBane RD, Grande JP, Sandhu GS, Melduni RM (2014) Treatment of cholesterol embolization syndrome in the setting of an acute indication for anticoagulation therapy. J Med Cases 5(6):376–379

    PubMed  PubMed Central  Google Scholar 

  • Kim DH, Seo SH, Ahn HH, Kye YC, Choi JE (2015) Characteristics and clinical manifestations of pigmented purpuric dermatosis. Ann Dermatol 27(4):404–410

    Article  Google Scholar 

  • Kirkland L (2009) Cholesterol embolism. Resource document. https://emedicine.medscape.com/article/460428-overview. Accessed 12 Mar 2021

  • Kronzon I, Saric M (2010) Cholesterol embolization syndrome. Circulation 122(6):631–641

    Article  Google Scholar 

  • Lal G, Nowell AG, Liao J, Sugg SL, Weigel RJ, Howe JR (2009) Determinants of survival in patients with calciphylaxis: a multivariate analysis. Surgery 146(6):1028–1034

    Article  Google Scholar 

  • Levi M, Sivapalaratnam S (2018) Disseminated intravascular coagulation: an update on pathogenesis and diagnosis. Expert Rev Hematol 11(8):663–672

    Article  CAS  Google Scholar 

  • Llamas-Velasco M, Alegría V, Santos-Briz Á, Cerroni L, Kutzner H, Requena L (2017) Occlusive nonvasculitic vasculopathy. Am J Dermatopathol 39(9):637–662

    Article  Google Scholar 

  • Miller K, Fischer M, Kamino H, Meehan S, Cohen D (2012) Purpura annularis telangiectoides. Dermatol Online J 18(12):5

    PubMed  Google Scholar 

  • Nazarian RM, Van Cott EM, Zembowicz A, Duncan LM (2009) Warfarin-induced skin necrosis. J Am Acad Dermatol 61(2):325–332

    Article  Google Scholar 

  • Nunley JR (2020) Calciphylaxis. Resource document. https://emedicine.medscape.com/article/1095481-overview. Accessed 12 Mar 2021

  • Park MY, Shim WH, Kim JM, Kim GW, Kim HS, Ko HC, Kim MB, Kim BS (2018) Dermoscopic finding in pigmented purpuric lichenoid dermatosis of Gougerot-Blum: a useful tool for clinical diagnosis. Ann Dermatol 30(2):245–247

    Article  CAS  Google Scholar 

  • Piette WW (2018) Cutaneous manifestations of microvascular occlusion syndromes. In: Bolognia JL, Schaffer JV, Cerroni L (eds) Dermatology, 4th edn. Elsevier Limited, Philadelphia

    Google Scholar 

  • Risikesan J, Sommerlund M, Ramsing M, Kristensen M, Koppelhus U (2017) Successful topical treatment of pigmented purpuric lichenoid dermatitis of Gougerot-Blum in a young patient: a case report and summary of the most common pigmented purpuric dermatoses. Case Rep Dermatol 9(3):169–176

    Article  Google Scholar 

  • Saric M, Kronzon I (2011) Cholesterol embolization syndrome. Curr Opin Cardiol 26(6):472–479

    Article  Google Scholar 

  • Sayin R, Bilgili SG, Karadag AS, Tombul T (2012) Sneddon syndrome associated with Protein S deficiency. Indian J Dermatol Venereol Leprol 78(3):407

    PubMed  Google Scholar 

  • Shabana (2012) Cholesterol embolisation syndrome. Resource document. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-11/Cholesterol-Embolisation-Syndrome. Accessed 12 Mar 2021

  • Theodoridis A, Makrantonaki E, Zouboulis CC (2013) Malignant atrophic papulosis (Köhlmeier-Degos disease) – a review. Orphanet J Rare Dis 8:10

    Article  Google Scholar 

  • Tolaymat L, Hall MR (2021) Pigmented purpuric dermatitis. [Updated 2020 Dec 13]. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519562/

  • Torraca PFS, Murback NDN, Wiziack NC, Freitas TCM, França GM (2017) Segmental lichen aureus: an uncommon presentation. An Bras Dermatol 92(5):704–706

    Article  Google Scholar 

  • Weedon D (2016) The vasculopathic reaction pattern. In: Weedon’s skin pathology, 4th edn. Elsevier, Churchil Livingstone, p 226

    Google Scholar 

  • Weenig RH, Sewell LD, Davis MD, McCarthy JT, Pittelkow MR (2007) Calciphylaxis: natural history, risk factor analysis, and outcome. J Am Acad Dermatol 56(4):569–579

    Article  Google Scholar 

  • Wohlrab J, Fischer M, Wolter M, Marsch WC (2001) Diagnostic impact and sensitivity of skin biopsies in Sneddon’s syndrome. A report of 15 cases. Br J Dermatol 145(2):285–288

    Article  CAS  Google Scholar 

  • Wu S, Xu Z, Liang H (2014) Sneddon’s syndrome: a comprehensive review of the literature. Orphanet J Rare Dis 9:215

    Article  Google Scholar 

  • Zaldivar Fujigaki JL, Anjum F (2021) Schamberg disease. [Updated 2020 Dec 4]. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560532/

  • Zouboulis CC, Theodoridis A, Brunner M, Magro CM (2017) Benign atrophic papulosis (Köhlmeier-Degos disease): the wedge-shaped dermal necrosis can resolve with time. J Eur Acad Dermatol Venereol 31(10):1753–1756

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Skin Disease and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran

    Ali Asilian, Fariba Iraji, Farahnaz Fatemi Naeini, Gita Faghihi, Fatemeh Mokhtari, Fatemeh Mohaghegh, Mina Saber & Samaneh Mozafarpoor

Authors
  1. Ali Asilian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fariba Iraji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farahnaz Fatemi Naeini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gita Faghihi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatemeh Mokhtari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fatemeh Mohaghegh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mina Saber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Samaneh Mozafarpoor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali Asilian .

Editor information

Editors and Affiliations

  1. Department of Pathology, Univ of Rochester School of Med, Rochester, NY, USA

    Bruce Smoller

  2. Khorramshahr, Iran

    Nooshin Bagherani

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Asilian, A. et al. (2021). Purpura and Microvascular Occlusion. In: Smoller, B., Bagherani, N. (eds) Atlas of Dermatology, Dermatopathology and Venereology . Springer, Cham. https://doi.org/10.1007/978-3-319-45134-3_95-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-45134-3_95-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-45134-3

  • Online ISBN: 978-3-319-45134-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation