Purpura is recurrent bleeding of the skin and mucous membrane, which causes appearance of visible purple spots, hence the name ‘Purpura’.
Normally, in any case of bleeding due to any injury, the bleeding gradually stops. This stoppage of bleeding is called Hemostasis.
Basically there are 3 stages of Hemostasis:-
- Vasoconstriction, that is, narrowing of blood vessels in the area of injury
- Platelet plug formation – platelets, one type of cells in our bloodstream aggregate at the site of injury to form a plug for stopping the flow of blood.
- Sealing by clotting factors
Now, defects in hemostasis(blood clotting) can be due to :-
- Decreased platelet production
- Defective platelets (non funtional)
- Normal production and function of platelets but there’s excessive storage of platelets in the spleen, which causes lower concentration of it in the bloodstream.
Defect in any of the above stages of hemostasis will cause bleeding problems and various types of Purpura.
We’re going to focus mainly on two tyoes of Purpura
1. Senile purpura and 2. Steroid induced purpura
Senile Purpura
It can be seen in patients who are above 50 to 55 years of age. For example, if we apply too much pressure while holding their hand or there’s any kind of friction or scratch, the area develops red or purple patches.
‘Senile’ means aging and ‘purpura’ refers to purple. Senile Purpura is a problem associated with aging only. It is not any kind of dangerous or fatal disease.
Mechanism of how symptoms are manifested in Senile Purpura :-
As we age, there is reduction in production of collagen and elastin in our body. This causes thinning of our skin and
makes our blood vessels fragile or weak.
That’s why, even in cases of minor injuries, there is defective vasoconstriction, which causes blood to come out of the blood vessels.
Our body defense system(macrophages) then tries to clear out the blood that has come out.
The macrophages destroy the Red Blood Cells (RBC) in the bbloo, which causes release of hemosiderin pigment from th
e RBC, which is brown in colour.
This sometimes causes the patches to be brown in colour.
Steroid Induced Purpura
This is caused by long term use of steroid ointments and creams on the skin.
Mostly people buy steroid creams to apply it on their face for brightening their face or to reduce pimples. However, in truth what’s happening is that their skin becomes thinner and this causes tge skin to appear bright or reddish. And this leads to them getting addicted to the steroid cream. However, its prolonged use makes the blood vessels fragile.
Any kind of pressure or minor injury will then cause red patches over the skin via the similar mechanism discussed above.
Cause
Apart from defect in Hemostasis, Purpura can also be cause by excessive exposure to direct sunlight.
Those who regularly work under the sun are more susceptible to photodamage.
This causes reduced collagen production in the body.
This makes the skin fragile.
Most Common site affected
Purpura can be seen anywhere in the body, even the face. But it is mostly found to occur in the extensor aspect of the hand, that is the surface, which is usually most exposed to sunlight.
Prevention
- When purpura occurs due to aging, it cannot be prevented but other factors causing Purpura can be cocontroll as mentioned below.
- Avoid excessive sunlight by using full sleeved clothes and broad-spectrum sunscreen.
- Take plenty of Vitamin C. Citrus fruits like Orange, lemon, guava etc. are rich in vitamin C.
- Do not use steroid cream without a dermatologist’s advice.
Treatment
- Purpura is benign condition, that is, it is not dangerous. It is self-limiting, which means that, given 1 to 3 weeks, the reddish or purple sots dissolve automatically.
- It is seen that ‘Arnica cream’ works in reducing the symptoms in some causes but still, it is not fully effective.
- It is best to avoid any excessive pressure, friction in the affected area.
- Use sunscreen, moisturizer containing Vitamin C and Vitamin E, which helps to keep the skin firm.
- Also Vitamin C tablets and supplements can be take as vitamin c helps the body produce collagen and strengthens the skin and blood vessels.
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Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.