Purpura simplex/easy bruising is a very common condition in the vascular purpura family [1]. This idiopathic skin manifestation occurs in healthy individuals and predominantly affects young women [2] [3]. Purpura refers to the deposition of red blood cells beneath the skin [1] although the mechanism of this type is unclear. There may be a hereditary component [4] or relation to medication use such as nonsteroidal anti-inflammatory drugs (NSAIDs) [5] [6]. Additionally, episodes of purpura simplex may manifest during the patient's menstrual period [1] [5].

The typical presentation of these patients is spontaneous bruising on thighs, upper arms, and/or buttocks accompanied by an otherwise unremarkable physical exam. A review of history reveals no trauma or preceding event. Very importantly, patients do not have a history of bleeding disorders, menorrhagia, or exaggerated bleeding with vaginal deliveries or surgery [7].

Generally, purpura describes unblanched reddish or purplish pigmented lesions, which measure at 3 to 10mm [8]. According to one study, the appearance of purpura simplex may be characterized as macular purpura and petechia [6].

The insignificant history of these patients is indicative of the benign nature of purpura simplex. Therefore, the prognosis of these patients is excellent and patients should be reassured [7]. Moreover, the majority of patients will have a resolution of the purpura [6].

• Asymptomatic

  They may be quite pruritic, although they are often asymptomatic. The lesions are often unilateral and localized to the legs but can involve the trunk and arms. [statpearls.com]

  Asymptomatic lesions have been seen more frequently. [scielo.br]

  Typically, the condition is asymptomatic, but pruritus may sometimes be a prominent feature in some cases, especially in patients with itching purpura or eczematidlike purpura of Doucas and Kapetanakis. These diseases have no systemic findings. [emedicine.medscape.com]

  Indian J Dermatol 2006;51:275-7 Pigmented purpuric dermatoses (PPD) are a group of benign dermatoses, occurring as result of lymphocytic capillaritis, increased capillary fragility and erythrocyte extravasation, characterized by asymptomatic nonpalpable [e-ijd.org]

  The lesions are asymptomatic and usually last several months with relapses and remissions. Unlike Schamberg's disease, Majocchi's disease is unassociated with venous stasis2811. [synapse.koreamed.org]

• Lymphadenopathy

  Systemic lupus erythematosus Lymphadenopathy Infection, drugs, malignancy Jaundice, spider angioma, palmar erythema, hepatosplenomegaly Liver disease Pallor, lethargy, generalized bone tenderness, hepatosplenomegaly, lymphadenopathy Leukemia Skeletal [aafp.org]

  […] hypertension: Cushing syndrome Mucocutaneous telangiectasia: HHT Ischemic tissue damage/gangrene: DIC Jaundice, ascites, spider angioma, abdominal distention, confusion, or splenomegaly: alcohol abuse or acute liver failure/cirrhosis Hepatosplenomegaly or lymphadenopathy [online.epocrates.com]

• Weight Loss

  loss Hematologic Malignancy ( Leukemia, Myelodyspastic syndrome, Lymphoma ) Malnutrition Alcoholic Liver Disease ( Alcohol ic Cirrhosis ) Vitamin C Deficiency Vitamin K Deficiency Bruising Physical Abuse Purpura Simplex Women with Bruising on arms and [fpnotebook.com]

  B symptoms (e.g., fever, night sweats, weight loss) are specific to lymphoma. [online.epocrates.com]

  Fever, lethargy, weight loss, bone pain, joint pain, pallor, lymphadenopathy and hepatosplenomegaly are characteristically absent. [aafp.org]

• Weakness

  Seite 75 - A weak solution of the chloride of soda may be employed for this purpose ; and if the disease occur in a child that is not able to gargle, this solution may be injected into the nostrils and against the fauces, by means of a syringe or elastic [books.google.de]

  The patient becomes weak and soon there is marked prostration with pain through the muscular structures and in the joints and limbs, and in the chest. Other hemorrhages soon follow. [henriettes-herb.com]

  Mixed cryoglobulinemia is characterized by the classical clinical triad of purpura, weakness, and arthralgias. [medtextfree.wordpress.com]

• Severe Pain

  A 19-year-old woman had a severe pain on her abdominal skin in February 1987 and eruption and vesicles formed. One week later FULL TEXT [annals.org]

  It has all the manifestations above described, developing more rapidly and is of a more severe type. It is accompanied with severe pain in the bowels, vomiting and severe diarrhea, and there may be intestinal and reual hemorrhage. [henriettes-herb.com]

• Easy Bruising

  Purpura simplex is a common, benign vascular purpura characterized by easy bruising. It typically affects healthy young women in absence of trauma or history of abnormal bleeding. [symptoma.com]

  Consider nutritional deficiencies, age related bruising, purpura simplex, drugs, and physical abuse in patients with a first episode of bruising. A 78 year old woman presents with a three month history of easy bruising. [bmj.com]

  From Jump to: navigation, search Contents 1 Epidemiology 2 Clinical-manifestations 3 Laboratory 4 More General Terms 5 References Epidemiology children & middle-aged women most frequently affected Clinical-manifestations easy bruising legs frequently [anvita.info]

  Medical Treatments Easy bruising is not serious and no drug can prevent its occurrence. [infolific.com]

  […] patient with easy bruising. [online.epocrates.com]

• Hemophilia A

  People with an unusual form of hemophilia B, known as hemophilia B Leyden, experience episodes of excessive bleeding in childhood, but have few bleeding problems after puberty. [findzebra.com]

  Intra-articular and intramuscular bleeding is suggestive of a severe coagulation factor deficiency (e.g., hemophilia). [online.epocrates.com]

  Lupus Erythematosus Ehlers-Danlos Syndrome Hypermobile joints Von Willebrand Disease Menorrhagia (most common), recurrent Epistaxis or Gingival Bleeding Often delayed diagnosis with normal basic coagulation labs (until platelet closure time is checked) Hemophilia [fpnotebook.com]

  Hemophilia is an inherited bleeding disorder. Bleeding disorders can also be a side effect of medicines such as blood thinners. Various blood tests can check for a bleeding disorder. You will also have a physical exam and history. [icdlist.com]

  Deficiencies of these factors, including factor VIII (hemophilia A) and factor IX (hemophilia B), will prolong the PTT. [aafp.org]

• Abdominal Pain

  Symptoms include a purple spotted skin rash, abdominal pain, gastrointestinal upsets, and joint inflammation, swelling, and pain. [encyclopedia.com]

  Other signs include worsening abdominal pain, increased vomiting, liver enlargement, high haematocrit with low platelet count, lethargy or restlessness. [dermatologytimes.com]

  She also reported abdominal pain and had vomited once. Physical examination revealed hypotension and multiple petechial bruises and purpura-like lesions over the four limbs and the face (fig 1 ⇓ ). [bmj.com]

  Chest pain, heart failure, arrhythmias, hypotension. Abdominal pain. Examination This may be normal. However, you may find: Fever. Purpura - non-palpable small purpuric spots or petechiae occur with thrombocytopenia, ie platelet count 9 /L. [patient.info]

  Fever, lethargy, weight loss, bone pain, joint pain, pallor, lymphadenopathy and hepatosplenomegaly are characteristically absent. [aafp.org]

• Loss of Appetite

  There is disability, loss of appetite, malaise and headache, with fever, but the temperature seldom rises above 103° F. The pulse becomes rapid and ultimately feeble. [henriettes-herb.com]

  Symptoms The onset of AP may be preceded by a headache, fever, and loss of appetite. Most children first develop an itchy skin rash. The rash is red, either flat or raised, and may be small and freckle-like. [encyclopedia.com]

• Blood in Stool

  […] in stools passing blood in urine (indicating kidney problems) fever, headaches and loss of appetite. [versusarthritis.org]

  […] cells or white blood cells) is depressed. [aafp.org]

• Hematochezia

  […] or with brushing], bites to lip and tongue, tooth eruption) — No Bleeding noted at least once Consultation only* Surgical hemostasis or antifibrinolytic Blood transfusion, replacement therapy, or desmopressin Gastrointestinal bleeding (hematemesis, hematochezia [aafp.org]

• Severe Abdominal Pain

  Symptoms include a purple spotted skin rash, abdominal pain, gastrointestinal upsets, and joint inflammation, swelling, and pain. [encyclopedia.com]

• Arthralgia

  Symptoms * Bruises * Bruising easily * Thigh bruise * Buttock bruise * Upper arm bruising * Normal platelet levels * Normal blood clotting Causes * Leukocytoclastic Vasculitis –A necrotizing vasculitis of small vessels –Fever, malaise, fatigue and arthralgias [checkorphan.org]

  Presentation There may be a prodrome resembling a flu-like illness, including fever, fatigue and generalised malaise and arthralgias. [patient.info]

  There was no preceding or concurrent history of injury, psychiatric illness, drug intake, nutritional imbalance or irregularity, bleeding from natural orifices, arthralgia, respiratory infection, central nervous system or gastrointestinal symptoms. [ijdvl.com]

• Contusion

  Mastitis 672 Measles 678 Smoke Inhalation 680 Urinary Retention 1172 Meniere Disease 686 Meningitis 688 Snake Envenomation 694 Mononucleosis 708 Multiple Sclerosis 714 Myasthenia Gravis 722 Myocardial Contusion 724 Myocarditis 726 Neuroleptic Malignant [books.google.es]

  "Bruises/Contusions." ForensicMD. Available online at http://www.forensicmed.co.uk/bruises.htm (accessed December 7, 2004). "Bruises, Ouch!" University of Iowa Health Science Relations. [healthofchildren.com]

• Purpura

  […] fulminans purpura fulminans purpura fulminans purpura gangrenosa purpura haemorrhagica purpura haemorrhagica purpura haemorrhagica purpura nervosa purpura nervosa purpura nervosa purpura nervosa purpura pigmentosa progressiva purpura pulicans purpura [medical-dictionary.thefreedictionary.com]

  (Purpura rheumatica, purpura simplex, peliosis rheumatica, capillarotoxicosis, purpura anaphylactoides, purpura allergica, purpura Schönlein-Henoch]. Radojicić B, Pekić B, Trajković B, Stanisić P, Miolin A. Radojicić B, et al. [pubmed.ncbi.nlm.nih.gov]

  Generally, purpura describes unblanched reddish or purplish pigmented lesions, which measure at 3 to 10mm. According to one study, the appearance of purpura simplex may be characterized as macular purpura and petechia. [symptoma.com]

• Petechiae

  Also found in: Dictionary, Thesaurus, Encyclopedia. pur·pu·ra sim·plex [MIM*179000] the eruption of petechiae or larger ecchymoses, usually unaccompanied by constitutional symptoms and not associated with systemic illness. [medical-dictionary.thefreedictionary.com]

  Purpura simplex ; the least complicated form of the " petechia sine febre" of authors, consisting only of minute effusions of dark blood under the cuticle, usually termed petechiae. Fig. 2. [medicusbooks.com]

  After completing this module, the learner should be able to: Identify and describe the morphology of petechiae and purpura. Outline an initial diagnostic approach to petechiae or purpura. [aad.org]

• Eruptions

  Pigmented purpuric eruptions. E. F. [semanticscholar.org]

  Also found in: Dictionary, Thesaurus, Encyclopedia. pur·pu·ra sim·plex [MIM*179000] the eruption of petechiae or larger ecchymoses, usually unaccompanied by constitutional symptoms and not associated with systemic illness. [medical-dictionary.thefreedictionary.com]

  In some patients, the eruption was related to medications. Treatment was usually of limited benefit. Fifty-eight of 87 patients (67%) who had follow-up data did eventually have clearing of lesions. [em-consulte.com]

  Some authors refer to the appearance of an urticarial eruption in rare cases. The petechial or hemorrhagic initial rash has a special predilection for certain regions of the body, which were carefully studied by Simon, of Hamburg. [books.google.com]

  This eruption typically begins on the lower legs but can spread proximally and may also occur on the arms and trunk. [statpearls.com]

• Erythema

  Erythema nodosa granuloma anulare, purpura rheumatica and other forms of purpura, acrodermatitis atrophicans Herxheimer, light dermatoses, eczema, urticaria, psoriasis, xanthomatoses, pemphigus, purpura, hyperglobulinemia Waldenstrom, hypogammaglobulinemia [eurekamag.com]

  […] areola bath become body bullae cause cells characters chronic cicatrix congestion constitutional symptoms crusts cure cutaneous derma desiccation desquamation developed disease disorder ecthyma eczema effusion elevations epiderma eruption erysipelas erythema [books.google.de]

  Petechiae, palpable purpura, and erythema multiforme lesions may occur. Linear or serpiginous bands of erythema may be seen at the margins of the palmar and/or plantar surfaces76 (see Plate XXV-22). [medtextfree.wordpress.com]

  They are heralded by a burning or stinging sensation, followed a few hours later, by oedema and erythema. Bruising occurs after a day or so. [ijdvl.com]

• Pruritus

  […] irritation itching latter legs lepra lichen lotion lymph mercury morbid mucous membrane nitrate of silver observed occasionally occurs ointment pain papillae papulac patches patient pemphigus period persons pimples pityriasis PLATE present produced prurigo pruritus [books.google.de]

  Medium to high potency topical corticosteroids such as triamcinolone can also be used and may improve pruritus and the inflammatory component of this condition. [statpearls.com]

  Typically, the condition is asymptomatic, but pruritus may sometimes be a prominent feature in some cases, especially in patients with itching purpura or eczematidlike purpura of Doucas and Kapetanakis. These diseases have no systemic findings. [emedicine.medscape.com]

  with Puva, 14 and another with topic pimecrolimus. 15 Despite the difficulties in the study of rare entities, research must be stimulated so that there may be epidemiological and pathophysiological evidence able to explain the symptoms of pain and pruritus [scielo.br]

  Pigmented purpuric dermatosis like variant of mycosis fungoides: can overlap or mycosis fungoides can evolve from pigmented purpuric dermatosis (Am J Dermatopathol 1997;19:108, Cutis 2014;94:297) This form shows large areas of confluence, violaceous hue and pruritus [pathologyoutlines.com]

• Suggestibility

  Want to suggest a symptom? Please send suggestions to RareGuru! [rareguru.com]

  Petechiae, and haematomas, when occurring without trauma, are suggestive of a bleeding disorder 2 (Box 1). [bmj.com]

  Access full-color images and more than 90 online-only topics at Expert Consult, as well as EBMs, Suggested Reading, Patient Teaching Guides, and additional algorithms. [books.google.com]

When evaluating bruising, which is common in primary care, the patient's history is an essential component in the diagnostic process. The clinician should investigate the patient's medical and family history with regards to bleeding and bruising disorders and whether there is a personal history of bleeding that is out of proportion to trauma such as childbirth and surgery [7] [9]. Furthermore, other significant factors for consideration are age and gender [9]. Other key questions should explore frequent causes of bruising such as physical abuse or trauma, use of medications such as anticoagulants, antiplatelet drugs, and NSAIDs, nutritional deficiencies, alcohol use, underlying diseases such as liver cirrhosis, or recent illness [9] [10].

Since the above inquiries for those with purpura simplex are unremarkable, the bleeding score system yields a negative score for these patients [7].

If laboratory tests are performed, all initial bleeding studies including a complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), and platelet function assay (PFA-100) are normal in patients with purpura simplex [7] [9]. Also, a peripheral blood smear can reveal the abnormalities of platelets [9]. Generally, these parameters evaluate different pathways of the clotting cascade. For example, the PT assesses the extrinsic and common pathways while PTT evaluates the intrinsic and common pathways [7].

Therefore, the prognosis of these patients is excellent and patients should be reassured. Moreover, the majority of patients will have a resolution of the purpura. [symptoma.com]

Diagnosis - Purpura simplex The list of diagnostic tests mentioned in various sources as used in the diagnosis of Purpura simplex includes: * Platelet tests * Blood clotting tests Prognosis - Purpura simplex Not supplied. [checkorphan.org]

Prognosis Many lesions persist or extend with time. Most eventually resolve spontaneously. [emedicine.medscape.com]

Prognosis: —The prognosis is unfavorable in most cases and should always be guarded. The danger depends upon the extent of the hemorrhages and the amount of blood lost. [henriettes-herb.com]

PMID: 7847422 Prognosis Karadag AS, Parish LC, Lambert WC Skinmed 2017;15(2):91-92. Epub 2017 Apr 1 PMID: 28528600 Ratnam KV, Su WP, Peters MS J Am Acad Dermatol 1991 Oct;25(4):642-7. doi: 10.1016/0190-9622(91)70246-x. PMID: 1791222 [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Nevertheless, treatments aiming to improve related etiologic factors might help in some cases. [synapse.koreamed.org]

PLATELET DYSFUNCTION Congenital Etiologies. [aafp.org]

Pathophysiology The etiology is unknown. [emedicine.medscape.com]

Abnormality of blood and blood-forming tissues Epistaxis Menorrhagia Abnormality of the eye Ptosis Abnormality of the integument Bruising susceptibility Purpura Etiology Baek G, Kim MH, Jue MS Skin Res Technol 2022 Nov;28(6):856-864. [ncbi.nlm.nih.gov]

From Jump to: navigation, search Contents 1 Epidemiology 2 Clinical-manifestations 3 Laboratory 4 More General Terms 5 References Epidemiology children & middle-aged women most frequently affected Clinical-manifestations easy bruising legs frequently [anvita.info]

Extravasation of red blood cells with marked hemosiderin deposition in macrophages is also found, and a rare granulomatous variant of chronic pigmented dermatosis has been reported. [3] Epidemiology Frequency United States Pigmented purpuric dermatoses [emedicine.medscape.com]

Epidemiology The incidence is rising as there is greater recognition of the condition. It is currently around 3.7 cases per million patients. TTP is rare, with a reported incidence of 6 per 1,000,000 per year in the UK. [patient.info]

[…] disease is refractory to treatment, even though there have been recent improvement reports, with Puva, 14 and another with topic pimecrolimus. 15 Despite the difficulties in the study of rare entities, research must be stimulated so that there may be epidemiological [scielo.br]

[…] dermatitis Pigment purpuric eruptions (Dermatol Clin 1985;3:165) Purpura simplex (J Am Acad Dermatol 1991;25:642) Capillaritis Inflammatory purpura without vasculitis ICD coding ICD-10: L81.7 - Pigmented purpuric dermatosis ICD-11: EF40.0 - Capillaritis Epidemiology [pathologyoutlines.com]

By concisely combining cutting-edge explanations of disease pathophysiology with practical approaches to the diagnosis and management of hematologic disorders, it provides an invaluable vade mecum for today's physicians and students needing to keep up [books.google.com]

Pathophysiology The etiology is unknown. [emedicine.medscape.com]

These conditions have a similar morphological appearance, characterized as violaceous macules in a net-like, arborized, or starry form but they differ in pathophysiology (Chart 1). [scielo.br]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

Aspirin and drugs that prevent blood clots (for example, warfarin), low body weight, prior use of corticosteroid drugs, and sun exposure may increase the risk of purpura simplex. This condition is not serious, and no treatment is needed. [msdmanuals.com]

No drug prevents the bruising; patients are often advised to avoid aspirin and aspirin-containing drugs. Patients should be reassured that the condition is not serious. All patients should be evaluated for the possibility of physical abuse. [merckmanuals.com]

1. Modi AV. Spontaneous Bruising in a Family Practice Population: How common and how benign is it? Can Fam Physician. 1992;38:1805-8.
2. Ramanan SV. A very rare bleeding disorder. BMJ : British Medical Journal. 1998;317(7170):1437.
3. Goroll AH, Mulley AG. Primary care medicine: Office evaluation and management of the adult patient. Philadelphia, PA: Lippincott Williams & Wilkins; 2006: 1247.
4. Davis E. Hereditary familial purpura simplex. Lancet. 1941; 237(6127):145-146.
5. Goroll AH, Mulley AG. Primary care medicine: Office evaluation and management of the adult patient. Philadelphia, PA: Lippincott Williams & Wilkins; 2006: 645.
6. Ratnam KV, Su WP, Peters MS. Purpura simplex (inflammatory purpura without vasculitis): a clinicopathologic study of 174 cases. J Am Acad Dermatol. 1991;25(4):642-647.
7. Ballas M, Kraut EH. Bleeding and bruising: a diagnostic work-up. Am Fam Physician. 2008;77(8):1117-24.
8. Mitchell RS, Kumar V, Robbins SL, Abbas AK, Fausto N, eds. Robbins basic pathology. 8th ed. Philadelphia, PA: Saunders Elsevier; 2007: 10–11.
9. Harrison LB, Nash MJ, Fitzmaurice D, Thachil J. Investigating easy bruising in an adult. BMJ. 2017;356:j251.
10. Neutze D, Roque J. Clinical Evaluation of Bleeding and Bruising in Primary Care. Am Fam Physician. 2016;93(4):279-86.