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Year : 2020  |  Volume : 21  |  Issue : 3  |  Page : 218-220

Childhood suction purpura: Analysis of seven cases

1 Department of Dermatology and Venereology, Uşak University, School of Medicine, Uşak, Turkey
2 Department of Dermatology and Venereology, Sakarya Karasu State Hospital, Sakarya, Turkey

Date of Submission22-Dec-2019
Date of Decision30-Jan-2020
Date of Acceptance26-Apr-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Dr. Omer Kutlu
Department of Dermatology and Venereology, Usak University, School of Medicine, Usak
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpd.IJPD_129_19

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In this case series, five girls and two boys presented with purpuric-ecchymotic lesions that appeared around their lips. All patients were under the age of 15. While patients did not reveal any history of trauma at the beginning, they later accepted a history of sucking their lips inside their mouths or suctioning cups. In addition to negative routine laboratory tests including parvovirus in these patients, the lesions disappeared in several days. To the best of our knowledge, childhood suction purpura was examined for the first time in this case series.

Keywords: Ecchymosis, parvovirus, purpura, suction

How to cite this article:
Kutlu O, Düzayak S. Childhood suction purpura: Analysis of seven cases. Indian J Paediatr Dermatol 2020;21:218-20

How to cite this URL:
Kutlu O, Düzayak S. Childhood suction purpura: Analysis of seven cases. Indian J Paediatr Dermatol [serial online] 2020 [cited 2021 Jun 21];21:218-20. Available from: https://www.ijpd.in/text.asp?2020/21/3/218/288490

  Introduction Top

Petechial and purpuric lesions caused by mechanical trauma are commonly observed in childhood. It is well known that numerous hematological diseases can also present with a purpuric manifestation in childhood.[1],[2] Suction purpura is a clinical manifestation characterized by small groups of bruises caused by negative pressure, particularly on circular areas of the body. To the best of our knowledge, no case series has been published on childhood suction purpura. In this series, seven cases who denied a mechanical reason for the manifestation at the start, despite insistent questioning, and then admitted to having suction purpura, are presented.

  Case Reports Top

A 14-year-old girl was brought to the clinic by her parents with the complaint of a bruise that appeared on her chin in the morning. The patient had no history of trauma and comorbidity. A similar complaint had been experienced 2 weeks previously. Multiple purpuric lesions started 1 cm below the lips and extended toward the chin, bordering both lip corners laterally as determined in the dermatologic examination [Figure 1]. Routine complete blood count, blood biochemistry levels of the patient, and coagulation parameters (thrombin time and partial thrombin time) were normal, and parvovirus markers were negative. The patient insistently denied a history of trauma. The lesion regressed in 3 days, and the patient accepted the a history of sucking her lips in her mouth at her control visit. Six additional cases are summarized in [Table 1].
Figure 1: Multiple purpuric lesions extended toward the chin

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Table 1: Demographic and clinical features of patients with suction purpura

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  Discussion Top

Purpura due to mechanical reasons is a common condition, particularly in childhood. Suction purpura is characterized by the observation of small ring-shaped petechial lesions on the skin due to external negative pressure.[1],[3] Suction purpura was first identified in the literature by Metzker and Merlob in 1992; however, no sufficient information has been published so far on this manifestation. In their report, Metzker and Merlob described neonatal pressure purpura, purpura caused by childhood habits, and suction purpura due to iatrogenic reasons.[1] Childhood suction purpura was examined for the first time in this case series. In our series, purpuric/ecchymotic lesions of the patients mostly appeared on waking up in the morning. Five of the patients were girls, whereas two patients were boys, and their age varied between 5 and 14 years. The patients had no erythema infectiosum accompanying purpura and their hematological and biochemical parameters were normal.

Although purpuric/ecchymotic lesions were mostly determined at the inferior of the lower lip, lesions were also determined above the upper lip and on the cheek. In cases involving the inferior of the lower lip, the area just below the vermilion line was not involved, separating from purpuric lesions with a sharp border [Figure 2]. This may be attributed to low negative pressure due to anatomical convexity throughout the vermilion line and it may be a clue for the diagnosis of suction purpura.
Figure 2: Multiple purpuric lesions that 1-cm area below the lip is not involved

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According to our series, one of the most characteristic properties of children with suction purpura is that they do not answer the question when asked about the occurrence of the lesions. They later explain to the physician that they did not do this. While children deny the situation despite insistent questioning, they may confess to their parents sucking on their lips and/or suctioning around cups a few days after the lesions have healed. The presence of erosion on the lips may be a clue to a sucking habit [Figure 3]. The recurrence of the condition may suggest that childhood suction purpura may be a subtype of habitual/factitial dermatitis. Furthermore, it may point to an underlying stress-related conditions. The evaluation of existing cases from a psychological aspect will result in further elucidation of this subject.
Figure 3: The presence of the erosion on the lips that a clue for childhood suction purpura

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Parents may be frightened since they mostly see the existing lesions after waking up in the morning. It should be stated that this manifestation is fully healed within several days, and parents should be reassured in this aspect.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Metzker A, Merlob P. Suction purpura. Arch Dermatol 1992;128:822-4.  Back to cited text no. 1
Aydinöz S, Karademir F, Süleymanoglu S, Ozkaya H, Göçmen I. Parvovirus B19 associated papular-purpuric gloves-and-socks syndrome. Turk J Pediatr 2006;48:351-3.  Back to cited text no. 2
Kaliyadan F. Dermoscopic pattern in a case of suction purpura over the face. Indian Dermatol Online J 2016;7:563-4.  Back to cited text no. 3
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  [Figure 1], [Figure 2], [Figure 3]

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