Purpura refers to purple-coloured spots or patches on the skin or mucous membranes due to bleeding underneath. These discolourations can range from small petechiae resembling a rash to larger, more pronounced bruise-like areas. While purpura is not a disease, it can be a visible sign of an underlying health condition that requires medical evaluation and management.

The appearance of purpura may seem alarming, but it stems from various potential causes, some relatively benign while others indicate more serious disorders.

Causes of Purpura

The causes of purpura can be categorised into several groups:

1. Blood Disorders

Thrombocytopenia: Low platelet count, which can be caused by various factors such as bone marrow failure, blood loss, or certain medications.
Haemophilia: Impaired blood clotting can lead to prolonged bleeding and bruising.
Von Willebrand Disease: A clotting protein deficiency that affects blood clotting.

2. Infections

Meningococcemia: A bacterial infection that can cause bleeding and bruising.
Sepsis: A severe infection that can lead to blood clotting disorders.
Endocarditis: An infection of the heart valves that can cause bleeding and bruising.
Viral Infections: Certain viral infections such as rubella, Epstein-Barr, or cytomegalovirus can cause purpura.

3. Medications

Blood Thinners: Medications like aspirin or anticoagulants that can increase the risk of bleeding.
Immunosuppressants: Medications that can affect platelet function and lead to purpura.

4. Allergies

Anaphylaxis: A severe allergic reaction that can cause purpura due to the release of chemicals that affect blood vessels.

Autoimmune Disorders

Systemic Lupus Erythematosus (SLE): An autoimmune disorder that can cause inflammation and damage to blood vessels, leading to purpura.
Vasculitis: Inflammation of blood vessels that can cause purpura
Immune Thrombocytopenic Purpura (ITP)

5. Nonthrombocytopenic Purpura

Weak Blood Vessels: Weak blood vessels can cause purpura due to leakage of blood under the skin.
Inflamed Blood Vessels: Inflamed blood vessels can cause purpura due to inflammation and damage to blood vessels.
Medications: Certain medications can cause purpura by affecting blood clotting or platelet function.

6. Other Causes

Congenital Disorders: Certain congenital disorders, such as telangiectasia or Ehlers-Danlos syndrome, can cause purpura.
Scurvy: A severe lack of vitamin C that can cause purpura.
Rocky Mountain Fever: A tick-borne illness that can cause purpura.

Diagnosis of Purpura

To diagnose purpura, a healthcare professional will typically perform a physical examination and ask about the patient’s medical history. They may inquire about any recent illnesses, medications, or potential exposures. Additional diagnostic tests may include:

1. Blood Tests:

Complete Blood Count (CBC): Provides information about platelet count, clotting factors, and signs of infection or underlying diseases.
Coagulation Studies: Evaluates the blood’s ability to clot properly and can identify any abnormalities in the clotting process.

2. Skin Biopsy:

Sometimes, a small sample of the affected skin may be taken for microscopic examination to determine the underlying cause of purpura.

3. Imaging Tests:

Ultrasound: Used to assess internal organs and blood vessels for any abnormalities or signs of bleeding.
CT Scan: Used to evaluate internal organs and blood vessels.
MRI: Used to evaluate internal organs and blood vessels.

4. Other Tests:

Urine Tests: These are used to check for evidence of blood, protein, or other abnormalities in the urine.
Kidney Biopsy: Used to diagnose kidney involvement in cases of severe purpura.

Treatment of Purpura

The treatment of purpura depends on the underlying cause and severity of the condition. Some common treatment approaches include:

1. Addressing the Underlying Cause

Medications: Antibiotics for infections, immunosuppressants for autoimmune disorders, and other medications to address the root cause of purpura.
Platelet Transfusion: In cases of severe thrombocytopenia, platelet transfusions may be necessary to restore normal clotting function.

2. Medication Adjustment

Adjusting Dosage: If medications are identified as the cause of purpura, adjusting the dosage or switching to alternative medications may be recommended.

3. Symptomatic Relief

Topical Treatments: Corticosteroid creams or ointments can help reduce inflammation and improve the appearance of the skin.

Supportive Care: General measures such as rest, elevation of affected limbs, and applying cold compresses can help reduce swelling and promote healing.

Risk Factors

Risk factors for purpura include:

Blood clotting issues: Caused by medication or disease.
Infectious diseases: It includes Rocky Mountain spotted fever, systemic lupus erythematosus, and severe infections.
Poor nutrition: Deficiencies in essential nutrients like vitamin C.
Certain forms of Cancer: Such as leukaemia.
Inflammatory conditions: Like rheumatoid arthritis.
Advanced age: Age-related reductions in subcutaneous fat and connective tissue.
Poor blood vessel health: Conditions such as atherosclerosis.

Accurate diagnosis is crucial for determining the appropriate course of action when purpura arises. Depending on the suspected cause, healthcare professionals may order blood tests, imaging studies, or even a skin biopsy to investigate further. With proper identification of the underlying issue, targeted treatment can help resolve the purpura while addressing any associated health problems.

Conclusion

A range of therapeutic options exists for different purpura-related conditions, from managing lifestyle factors to specific medications or procedures. By understanding the causes, diagnostic approaches, and available treatments, individuals can work closely with their healthcare providers to effectively manage purpura and safeguard their overall well-being.

Reference links:

https://my.clevelandclinic.org/health/symptoms/22695-purpura
https://www.health.com/purpura-7568054
https://www.ncbi.nlm.nih.gov/books/NBK448130/