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The Clinical Manifestations and Etiologic Factors of Patients with Pigmented Purpuric Dermatoses

Abstract

BACKGROUND: Pigmented purpuric dermatoses comprise a group of benign dermatoses that are clinically characterized by pinpoint petechiae and purpura on the hyperpigmented base, and histologically by capillaritis without any fibrinoid necrosis of the vessel. The etiology of pigmented purpuric dermatoses is unknown. Identification of triggering factors will contribute to find out the pathogenesis of the pigmented purpuric dermatoses. OBJECTIVES: The aim of this study was to investigate the clinical manifestations of pigmented purpuric dermatoses and to elucidate the relationship between the causative factors and clinical manifestation of pigmented purpuric dermatoses. METHODS: Clinical observation and review of medical records, photographs, and histopathologic specimens were made by analyzing 37 cases of patients with pigmented purpuric dermatoses who visited Our Lady of Mercy Hospital from 1995 to 2003. The present medical status of each patient was surveyed by phone and detailed reviews of the clinical records included attention to clinical manifestations, possible etiologic factors and coexisting diseases of each patient. The statistical methods used was one-way ANOVA test. RESULTS & CONCLUSIONS: The results were as follows; 1. Female to male ratio was 1.47: 1. The mean age at diagnosis was 45.6+/-17.2 years. 2. The mean duration of disease was 10.2+/-9.0 months, and the disease that localized to the lower limbs was in 75.7% of patients. 3. Of the 37 patients, 23 patients were of the Schambergs disease (62.2%), 11 patients were of the Majocchis disease (29.7%), 2 patients were of the Lichen aureus (5.4%), and one patient was of the Eczematid-like purpura of Ducas and Kapetanakis (2.7%). 4. The 37 patients were treated with topical or systemic steroid (73%), pentoxyfylline (10.8%), and there was no difference in the clinical course according to the treatment. Of the 37 patients, 18 patients had improvement or clearing of their lesions. 5. The etiologic factors identified were, orthostatic hypertension (21.6%), exercise (8.1%), metals (5.4%), NSAIDs (2.7%), heat (2.7%), and a wide spectrum of disease was present in patients with pigmented purpuric dermatoses. 6. The 14 of 22 patients without etiologic factors had medical problems, whereas 3 of 15 patients with etiologic factors had medical problems. The 5 of 15 patients with etiologic factors had clearance or improvement of their lesions, but 13 of 22 patients without etiologic factors had clearance or improvement of their lesions.

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