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LETTER TO EDITOR
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 168-169

Dermoscopic perspective of pressure purpura: A report of three cases


1 Department of Pediatric Dermatology, Cloudnine Hospital, Bengaluru, Karnataka, India
2 Department of Dermatology, S N Medical College, Bagalkot, Karnataka, India

Date of Submission02-May-2020
Date of Decision12-May-2020
Date of Acceptance17-May-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Samipa Samir Mukherjee
Department of Dermatology, Cloudnine Hospitals, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_76_20

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How to cite this article:
Mukherjee SS, Ankad BS. Dermoscopic perspective of pressure purpura: A report of three cases. Indian J Paediatr Dermatol 2021;22:168-9

How to cite this URL:
Mukherjee SS, Ankad BS. Dermoscopic perspective of pressure purpura: A report of three cases. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Apr 18];22:168-9. Available from: https://www.ijpd.in/text.asp?2021/22/2/168/312830



Sir,

Dermoscopy is a proven adjunctive technique in the diagnosis of vascular lesions which form a considerable chunk of dermatological conditions in pediatric age group.[1] Purpura occurs due to the extravasation of red blood cells in the cutaneous tissue. Different forms of purpura result from inflammatory and noninflammatory changes within the blood vessel walls. Purpura in children may arouse anxiety in the parents and diagnostic dilemma in the treating physician, warranting a plethora of investigations.[1] We present three cases of pressure purpura on the face and neck diagnosed by dermoscopy.


  Case 1 Top


A 4-year-old girl was brought with asymptomatic red-colored rashes around the eyes and side of the neck [Figure 1]a since two days. On examination, the lesions were purpuric, but not palpable. Her father gave the history, that following vaccination the child hsd cried incessantly for a couple of days prior to the appearance of the rash. No medical intervention was done prior to this in the previous 2 days. Written consent was taken from parents.
Figure 1: (a) Clinical image of pressure purpura showing tiny red dots on the side of the right eye (box indicates the site of dermoscopy). (b) Dermoscopy of pressure purpura reveals scattered red globules (black arrows). Note the irregularity of red globules in terms of size and shape. (ILLUCO, Polarized dermoscopy, ×10)

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  Case 2 Top


A 7-year-old girl presented with asymptomatic red rashes around the mouth [Figure 2]a since three days. Examination revealed purpuric rash around the mouth in a well–demarcated, round configuration. There was no remarkable history of fever, medications, home remedies, lip licking, or trauma. On further probing, the child gave a history of sucking the milk cup and the water glass after finishing the milk as a part of child's play. Written consent was taken from parents.
Figure 2: (a) Clinical image of pressure purpura showing tiny red dots on the perioral area (box indicates the site of dermoscopy). (b) Dermoscopy of pressure purpura reveals red globules (black arrows) in a pseudo network-like pattern (ILLUCO, Polarized dermoscopy, ×10)

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  Case 3 Top


A 17-year-old girl came with reddish asymptomatic rashes on the anterior neck [Figure 3]a of 1-day duration. On examination, the lesions were purpuric, however not palpable. The patient gave a history of incessant coughing over the last 4–5 days followed by development of these rashes. Written consent was taken from the patient.
Figure 3: (a) Clinical image of pressure purpura showing tiny red dots on the anterior neck. (b) Dermoscopy of pressure purpura shows homogeneous red globules (black arrows) (ILLUCO, Polarized dermoscopy, ×10)

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Dermoscopy in all the three patients showed purpuric red dots and globules [Figure 1]b, 2b and 3b]. However, in the second case [Figure 2]b, red globules were arranged in semicircular and annular fashion, giving a pseudo network-like pattern. Dermoscopy of suction[2] and postvomiting purpura[3] has been described in literature. There is not much variation in the dermoscopic patterns in pressure purpura. Nevertheless, perioral lesions show pseudo network-like pattern.[2] In this study, similar pattern was noted in perioral lesions, whereas red purpuric globules were observed in the neck and periocular lesions. Dermatoscopy of purpuric lesions can provide a clue as to the origin of the purpura- inflammatory (mottled purpuric pattern) or non inflammatory (homogeneous purpuric pattern).[1]

Acquired portwine stain is an important differential in this scenario. Dermoscopy of acquired portwine stain shows red globules with multiple, short, linear vessels, which are connected with each other giving “serpiginous” pattern.[4]

To conclude, dermoscopic evaluation of pressure purpura is reported here to highlight that purpura in the head, neck, and face area in an otherwise healthy individual can be a result of excessive straining due to crying, coughing, vomiting or sucking on cups or glasses (suction purpura). Although the presence of a purpura can be confirmed using diascopy, dermoscopy provides additional clue to the etiology of the condition, thus proving to be of additional benefit in obviating the necessity for unnecessary investigations.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vazquez-Lopez F, García-García B, Sanchez-Martin J, Argenziano G. Dermoscopic patterns of purpuric lesions. Arch Dermatol 2010;146:938.  Back to cited text no. 1
    
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. 2
[PUBMED]  [Full text]  
3.
Kaliyadan F, Kuruvilla JP. Post-vomiting purpura. Indian Dermatol Online J 2016;7:456-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Ankad BS, Arora P, Sardana K, Bhardwaj M. Differentiation of acquired port wine stain and angioma serpiginosum: A dermoscopic perspective. Int J Dermatol 2019;58: e62-4.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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