Pigmented purpura dermatosis and viral hepatitis: a case-control study

Pigmented purpuric dermatosis persistent over 20 years treated with an ozone nanobubble water oral rinse: A case study

Pigmented purpuric dermatosis is a rare, unique purpuric skin disorder, most commonly located on the lower extremities and characterized by petechiae with tiny red rashes and brown pigmented patches. The precise etiology and a reliable treatment have not been established. This case report presents a 72-year-old female with repeating purpuric, tiny rashes and persistent extensive brown pigmented patches with pigmented purpuric dermatosis on both lower extremities for the past 20 years. Ozone nanobubble (ONB) water is a new sterilizing agent containing dissolved nanosized ozone gas bubbles in water. The patient performed an oral rinse every night with ONB water and was successfully treated. However, vitamin C administration and Ruby laser treatment were needed to reduce residual pigmentation. This case suggests that oral bacteria may be a causative factor of pigmented purpuric dermatosis.

Dermatoscopic findings of pigmented purpuric dermatosis

Background:

Pigmented purpuric dermatosis is a chronic skin disorder of unknown aetiology characterised by symmetrical petechial and pigmented macules, often confined to the lower limbs. The aetiology of pigmented purpuric dermatosis is unknown. Dermatoscopy is a non-invasive diagnostic technique that allows the visualisation of morphological features invisible to the naked eye; it combines a method that renders the corneal layer of the skin translucent with an optical system that magnifies the image projected onto the retina.

Objectives:

The aim of this study is to investigate the dermatoscopic findings of pigmented purpuric dermatosis.

Methods:

This study enrolled patients diagnosed histopathologically with pigmented purpuric dermatosis who had dermatoscopic records. We reviewed the dermatoscopic images of PPD patients who attended the outpatient clinic in the Istanbul Dermatovenereology Department at the Bezmialem Vakıf University Medical Faculty.

Results:

Dermatoscopy showed: coppery-red pigmentation (97%, n = 31) in the background, a brown network (34%, n = 11), linear vessels (22%, n = 7), round to oval red dots, globules, and patches (69%, n = 22; 75%, n = 24; 34%, n = 11; respectively), brown globules (26%, n = 8) and dots (53%, n = 17), linear brown lines (22%, n = 7), and follicular openings (13%, n = 4).

Conclusion:

To our knowledge, this is the first study to report the dermatoscopy of pigmented purpuric dermatosis. In our opinion, dermatoscopy can be useful in the diagnosis of pigmented purpuric dermatosis.

Clinical and laboratory findings of pigmented purpuric dermatoses

Background

Pigmented purpuric dermatoses (PPD) are chronic, recurrent group of disorders characterized by petechial and pigmentary macules usually localized on the lower limbs. Its etiopathogenesis is unknown. There are very few clinical and etiological studies on PPD in the literature.

Objective

We aim to examine the etiopathogenetic factors of PPD retrospectively.

Methods

Demographic characteristics, history of co-morbid disorders and drug usage, hepatitis markers, levels of serum lipids, findings of Doppler ultrasonography in lower extremities, and patch test results of the 24 patients of PPD were examined retrospectively. The patch test results, history of drug use, and co-morbid disorders of the patients were compared with those of the control groups.

Results

The male-to-female ratio was 1 : 2, and 83.3% of the patients had Schamberg disease. Seventeen patients had co-morbid disorders and 16 used various drugs, but there was no statistically significant difference between the controls and patients. One patient was positive for hepatitis B surface antigen and 1, for anti-hepatitis C virus antibody. Nine had elevated total cholesterol levels, and 5 had elevated triglyceride levels. Further, 30% of them were positive for at least 1 allergen, while 16% of the control subjects were positive for at least 1 allergen, but statistically significant difference was not found between the 2 groups. Variable degrees of venous insufficiency were detected in 75% of the patients on Doppler ultrasonography of the lower extremities.

Conclusion

Venous insufficiency and hypercholesterolemia might be the basic predisposing factors for PPD. Further studies are needed to show if diabetes mellitus and hypertension may cause perivascular inflammation in PPD.