Dermatology - Thrombocytopenic Purpura

Dermatology - Thrombocytopenic Purpura
Thrombocytopenic purpura is a condition where there is a decrease in the number of platelets in the blood, leading to the development of skin hemorrhages. These hemorrhages can occur either at sites of minor trauma or pressure when the platelet count is below 40,000/μL, or they can happen spontaneously when the platelet count is below 10,000/μL. The low platelet count in thrombocytopenic purpura can be caused by reduced platelet production, splenic sequestration, or increased platelet destruction.

Petechiae are tiny red spots that do not fade when pressed and cannot be felt. Over time, they change color from red to brown and may develop a yellowish-green hue. Ecchymoses are discolorations characterized by the presence of black-and-blue dots, which indicate a more extensive occurrence of bleeding. Vibices are elongated areas of bleeding that occur as a result of physical injury or pressure. Lesions are typically found on the legs and upper trunk, however they can occur in any location.
Petachiae may be observed on the palate, accompanied by gingival hemorrhage.

The diagnosis is established through clinical examination and subsequently confirmed by laboratory tests and platelet count assessment. Exclude HIV infection (using ELISA test) and vasculitis (via biopsy). The differential diagnosis comprises senile purpura, scurvy, progressive pigmentary purpura (Schamberg disease), purpura resulting from severe Valsalva maneuver (coughing, vomiting/retching), traumatic purpura, factitious or iatrogenic purpura, and vasculitis.

Determine the root cause of thrombocytopenia and rectify it, if feasible. Oral glucocorticoids, high-dose intravenous immunoglobulins, platelet transfusion, or splenectomy may be necessary.