Updated: 12/13/2019

Senile Purpura

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Topic
Snapshot
  • A 68-year-old woman is bothered by easy bruising. She recalls that even reaching into her purse can cause bruising along the sides of her arms. These bruises resolve on their own, but they bother her cosmetically. She is otherwise healthy and is not taking any medications.
Introduction
  • Non-inflammatory purpura presenting as ecchymotic lesions on sun-damaged skin
  • Epidemiology
    • seen in patients > 65 years of age
      • dermal tissue atrophy
      • blood vessel fragility
  • Also known as actinic purpura or solar purpura
  • Associated with
    • sun exposure
    • anticoagulants
    • corticosteroids
Presentation
  • Symptoms
    • easy bruising with minimal or no trauma
    • heals on its own
  • Physical exam
    • non-palpable, purple bruises
    • fade to brown (hemosiderin deposits)
    • commonly on sun-exposed skin
      • forearms
      • dorsal hands
Evaluation
  • Diagnosis made by clinical history and exam 
Differential
  • Solar lentigo
  • Geriatric abuse
Treatment
  • None
Prognosis, Prevention, and Complications
  • Prognosis
    • purpura may resolve after weeks
    • residual hyperpigmentation (brown color) may remain
    • no other health consequences
    • no indication of severe bleeding elsewhere

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Questions (1)

(M2.DM.17.4774) A 79-year-old woman with a history of osteoporosis and colon cancer presents to her primary care physician with complaints of bruising on her hands and arms. She states that she initially noticed scattered bruises on the backs of her hands one month prior, which have since slightly enlarged and coalesced into larger areas. She denies recent trauma to her hands and arms and has no family history of bleeding diatheses. Her medications include atorvastatin, zolendronic acid, a calcium supplement, and a daily multivitamin. The patient’s temperature is 98.6°F (37.0°C), pulse is 65/min, blood pressure is 140/75 mmHg, respirations are 12/min, and oxygen saturation is 99% on room air. Physical exam is notable for a thin, elderly woman with prominent kyphosis. Cardiopulmonary exam is unremarkable, capillary refill is 2 seconds, and part of the skin exam shown in Figure A. Laboratory results are below:

Serum:
Na+: 140 mEq/L
Cl-: 107 mEq/L
K+: 4.5 mEq/L
HCO3-: 22 mEq/L
Urea nitrogen: 15 mg/dL
Creatinine: 0.8 mg/dL
Glucose: 104 mg/dL

Hemoglobin: 12.4 g/dL
Leukocyte count: 9,800/mm^3
Platelet count: 150,000/mm^3

Which of the following is the next best diagnostic step in this patient?

QID: 109115
FIGURES:
1

Bleeding time

8%

(3/39)

2

Prothrombin time

15%

(6/39)

3

Carcinoembryonic antigen (CEA) levels

0%

(0/39)

4

Urine porphyrin levels

18%

(7/39)

5

No additional diagnostic tests required

59%

(23/39)

M 6 E

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