Review Question - QID 109115

This elderly patient presents with bruises and ecchymoses of the dorsal hands and forearms in the setting of diffusely sun-damaged skin, most consistent with senile purpura. No further workup or treatment is needed.

Senile purpura is characterized by localized areas of ecchymoses and purple discoloration, most commonly on the dorsal hands and forearms in elderly individuals. Patients typically have a history of chronic sun exposure leading to UV-damaged skin, and the skin appears very thin. This is caused by connective tissue atrophy leading to increased fragility of cutaneous blood vessels and subsequent bleeding into the skin. No extensive testing is needed if the clinical suspicion for senile purpura is strong, as this condition is harmless.

Figure A shows senile purpura of the forearm and hand.

Incorrect Answers:
Answer 1: Bleeding time is used for assessing bleeding due to platelet dysfunction. While this patient does have cutaneous bleeding, she has no history of epistaxis or other mucosal bleeding that would be more suggestive of a platelet-mediated bleeding disorder such as von Willebrand’s disease.

Answer 2: Prothrombin time (PT) is a test that would be useful in assessing for potential coagulopathy. While this patient does have cutaneous bleeding, she has no other personal or family history of coagulopathy including hemarthrosis or prior easy bruising that would be more indicative of a bleeding diathesis.

Answer 3: Carcinoembryonic antigen (CEA) levels may be elevated in the setting of certain malignancies (especially colon cancer) as well as other GI pathologies. This patient has a prior history of colon cancer, but her skin changes as described in the prompt are likely unrelated.

Answer 4: Urine porphyrin levels may be helpful in the diagnosis of porphyria cutanea tarda (PCT). PCT presents with vesicles and hemorrhagic crusting with erosions, most commonly of the dorsal hands. The isolated areas of ecchymoses seen in this patient would not be consistent with PCT.

Bullet Summary:
Senile purpura is a common manifestation of connective tissue atrophy, most frequently seen on the dorsal hands and forearms of elderly individuals with a history of chronic sun exposure. No additional diagnostic workup or treatment is required.