What is purpura?
Purpura is a condition in which there is extravasation of blood into the skin or mucous membranes, causing painless purplish spots of varying sizes. If these spots are very small and in large numbers they are called petechiae and when larger they are called ecchymoses.
There are so-called thrombocytopenic purpuras, in which there is a decrease in platelets - also called thrombocytes - (blood cells that initiate the blood clotting process, closing small hemorrhages) and non-thrombocytopenic purpuras, in which there is no decrease in platelets.
There is a modality of purpura called idiopathic thrombocytopenic purpura. The term purpura is related to the main manifestations of the disease (purplish, purplish skin spots); thrombocytopenic, refers to a drop in the number of platelets and difficulty in blood clotting, and idiopathic, refers to the fact that the cause of the disease has not yet bee.
Petechiae vs Purpura
Petechiae are small red or purple spike-sized spots on the skin. They are caused by bleeding from small blood vessels in the skin and can appear as a result of minor trauma or infection. Purpura are larger areas of purple or red discoloration on the skin, measuring 1 cm or more in diameter.
The reason behind the diseases is bleeding from blood vessels in the skin.
Petechiae is a condition in which there is skin discoloration. In this situation, small spots of different colors occur. They are mostly red, pink or purple. These spots occur within the skin layer. Due to the rupture of blood vessels present under the skin, which causes bleeding.
Purpura is another condition where there is skin discoloration. It is similar to the situation of small spots of mainly red, pink or purple colors. Also caused due to the rupture of blood vessels present under the skin which causes bleeding. However, they are larger in size.
Pictures of Purpura
Causes of Purpura
Purpura occurs when small blood vessels gather or leak under the skin, and there are many possible causes for the condition, the reasons that lead to its occurrence depend very much on the type of problem.
For example, non-thrombocytopenic purpura can arise through:
- amyloidosis
- Coagulopathies
- Congenital cytomegalovirus
- Congenital rubella syndrome
- Drugs that affect platelet function
- Fragile blood vessels
- Hemangioma
- Inflammation of blood vessels (vasculitis)
- Pressure changes that occur during vaginal delivery
- scurvy
- Use of steroid medications
Thrombocytopenic purpura appears as a result of:
- Medicines that prevent the formation of platelets
- Neonatal immune thrombocytopenia (may occur in babies whose mothers have ITP)
- Meningococcemia (a type of raised purpura)
What are the risk factors for purpura?
The dermatologist argues that there are numerous potential risk factors for purpura.
• Any hematological disease can lead to a drop in the number of platelets;
• Any infectious, inflammatory or autoimmune disease can lead to the fragility of the vessels in the skin;
• Age is also a risk factor: we speak of "senile" purpura in the elderly;
Chronic venous insufficiency also increases the risk of purpura due to the pressure exerted on the blood vessels, particularly in the lower limbs: purpura often evolves into brown patches called ocher dermatitis.
Types of Purpura
There are several types of purpura according to their cause, the main ones being:
1. Henoch-Schonlein purpura
Henoch-Schonlein purpura, also known as HSP, nephropathy or IgA vasculitis, is more common in children, however it can also be noticed in adults.
How to identify: This type of purpura is characterized by inflammation of small vessels, leading to the appearance of red spots, especially on the legs and buttocks, and can lead to pain in the joints or abdomen.
How to treat it: Normally, HSP does not require specific treatment, it is just important that the person rests and is monitored by a doctor to assess the progression of symptoms. However, when there is a lot of pain, the doctor may prescribe the use of anti-inflammatories or analgesics, such as Ibuprofen and Paracetamol, to relieve pain.
2. Idiopathic Thrombocytopenic Purpura
ITP, also known as idiopathic thrombocytopenic purpura, is an autoimmune condition that affects the clotting process by causing platelet counts to drop.Due to this defect in blood clotting, individuals' bodies are more prone to bleeding episodes. It is estimated that currently around 10,000 people are affected by the disease, which is more frequent in women (especially when they are of childbearing age).
In ITP, platelet production is impaired. This deficiency will compromise the patient's coagulation cascade, causing bleeding. These bleedings have petechiae as their main clinical manifestation, mainly in the skin and mucosa.
How to identify: Due to the change in clotting, it is possible to notice the formation of small red dots on the skin and nosebleeds. The diagnosis is made mainly through the analysis of the symptoms and the blood test, which in these cases indicates less than 10,000 platelets/mm³ of blood.
How to treat it: Treatment for ITP is carried out according to the severity of the symptoms, and the use of drugs that reduce the function of the immune system, preventing a reaction against the body itself, injection of immunoglobulins or drugs that stimulate the production of platelets by the bone marrow, such as Romiplostim, for example.
SEE SOME IMPORTANT RECOMMENDATIONS TO LIVE WELL WITH PTI
Habits:
• Know your family's medical history and provide a copy to your doctor;
• Keep a detailed list of your symptoms and when you had them (many symptoms come and go, aren't constant, or happen infrequently in autoimmune disorders). Get the opinion of more than one doctor if you feel that your health problems are not being treated properly;
• Maintain a healthy diet and lifestyle;
• Maintain a healthy digestive system by eating mostly fruits and vegetables and chewing well. Maintain healthy levels of vitamin B12, folic acid and vitamin D, which can bolster the immune system in an attempt to ward off serious infections – a known cause of low platelets;
• Make an effort to reduce your stress level – stress-reducing activities include Yoga, Meditation and relaxation techniques Avoid environmental toxins;
3. Thrombotic thrombocytopenic purpura
Thrombotic Thrombocytopenic Purpura or TTP is a rare type of purpura that can be life-threatening. This type of purpura is characterized by increased platelet aggregation, leading to thrombus formation and causing red blood cells to rupture. Thus, it is important that TTP be quickly identified and treated as soon as possible to avoid anemia, platelet loss and neurological changes.
How to treat it: Treatment for TTP should be started as soon as possible, and plasmapheresis is usually recommended, which corresponds to a blood filtration process in which excess antibodies that may be harming the functioning of the body and circulation blood is removed.
4. Purpura fulminans
Purpura fulminans appears mainly in newborns due to the lack of proteins related to coagulation, which leads to the formation of clots that can hinder blood circulation. In addition, this type of purpura can occur as a result of a serious blood infection, especially meningococcus.
How to identify: Due to the change in the clotting process, the appearance of red spots on the skin that can become black due to the death of cells in these places.
Treatment: Purpura fulminans can be treated by injecting the blood with the clotting protein that is absent, as directed by the doctor.
5. Senile purpura
This type of purpura occurs due to the natural aging of the body, which leads to greater fragility of blood vessels, and is more common in people aged 65 and over.
How to identify: As a result of the aging of blood vessels, it is possible to notice the appearance of purple spots on the back, wrists, hands and forearms.
How to treat it: Senile purpura does not need to be treated, since it does not pose a risk to health and is not indicative of bleeding. However, if the person feels uncomfortable, they can use some types of creams or ointments with vitamin K that help to reduce the spots, and should be indicated by the dermatologist.
Disease prognosis
Generally, purpura heals on its own a few weeks after its appearance, so it usually has a good prognosis. However, in some cases, it becomes a chronic disease when it does not go away after six months.
Purpura: Complications
Complications of purpura include:
• Organ damage
• Necroses
Speaking of organ damage, purpuras linked to immunological disorders (such as rheumatoid purpura in children) can cause lesions elsewhere than in the skin. Blood coming out of the vessels inside the body can affect the kidneys, digestive system, joints, etc. More rarely, the damage will affect the lungs, testicles, nervous system and bladder.
With regard to necrosis, it constitutes a destruction of the tissue where the hemorrhage takes place. This abnormal cell death is often associated with severe pain and high fever. Early treatment is recommended.
Can it be prevented?
Due of its connection to blood components, particularly platelets, purpura cannot be prevented.
Diagnosis of Purpura
The diagnosis of purpura is based on the observation of symptoms and confirmation by a few tests. In this context, the presence of red, purple or brownish patches or spots on the skin is the suggestive sign. They do not disappear when pressure is applied to the skin: this is the vitropression test. If the doctor suspects an origin linked to meningitis, he begins the treatment urgently without waiting for the results of other examinations. Remember, this situation is vitally important for the patient.
In other cases, the blood test will make it possible to control the level of platelets in the blood in order to detect a possible thrombocytopenia. An inflammatory syndrome can also be detected using certain markers such as CPR (Protein C Reactiv). In the presence of abnormal levels of red and white blood cells, the doctor may prescribe additional tests (myelogram) to determine a pathology of the bone marrow.
In addition, the creatine level can detect any underlying kidney disease. Urine tests may also be performed to check the proper functioning of the kidneys especially in case of symptoms associated with rheumatoid purpura.
Purpura: Prevention
Prevention will not concern anticipations of the occurrence of the disease. Indeed, it is difficult to adopt a preventive approach in relation to the fragility of the small blood vessels of the skin. However, complications can be prevented as soon as the disease begins. In this dynamic, it is necessary to avoid trauma, even the most minimal, such as friction or strictures (by the elastics of clothing, for example).
In addition, it is important to adopt and maintain a healthy lifestyle in order to delay the aging of tissues. Finally, when purpura presents with spots with a diameter greater than 3 millimeters, emergency care must be sought to initiate antibiotic treatment against the bacteria in question.
Treatments of purpura
Patients with mild immune thrombocytopenia might just need routine testing for platelets and monitoring.
Children usually recover without treatment. The majority of individuals with immune thrombocytopenia will ultimately require therapy since the illness frequently gets worse or is long-lasting (chronic).
Numerous methods of treatment are possible, such as splenectomy surgery or taking drugs to raise platelet count. Discuss the advantages and disadvantages of your treatment choices with your doctor. Some people find the side effects of treatment to be more bothersome than the effects of the disease.
Treatments for purpura vary depending on the form of the disease. Thus, we distinguish:
*Emergency treatment for purpura
*Treatment of vascular and rheumatoid purpura
• Treatment of urgent case of purpura
This is purpura linked to certain bacteria, including meningococcus, streptococcus or staphylococcus. This form is a vital emergency for which it is recommended to contact the SAMU quickly. The attending physician, faced with the suggestive signs, will begin treatment without waiting for confirmation of the diagnosis. Treatment will consist of intravenous administration of an antibiotic.
• Treatment of vascular and rheumatoid purpura
Depending on the symptoms, treatment may consist of simply taking rest or using steroids and immunosuppressants. This last measure is controversial, even it can always be considered in the event of renal or gastrointestinal damage.
Medicines
Your doctor will go through any over-the-counter drugs or supplements you use with you and advise you on whether you should stop using any that might impair platelet function.
Some examples are aspirin, ibuprofen (Advil, Motrin IB, others), and ginkgo biloba. Some of the medicines to treat immune thrombocytopenia may include the following:
1. Steroids: Your doctor may start you on an oral corticosteroid, such as prednisone. Once your platelet count has returned to a safe level, your. doctor will tell you if you can gradually stop taking the medication. Long-term use of these drugs is not recommended because they may increase the risk of infections, hyperglycemia, and osteoporosis.
2. Immunoglobulin: If corticosteroids are ineffective, your doctor may administer an injection of immunoglobulin. The use of this drug is also possible in cases of serious bleeding or the urgent need to boost your blood count before surgery. In a few weeks, the impact normally disappears.
3. Drugs that encourage the creation of platelets: Drugs like romiplostim (Nplate) and eltrombopag (Promacta) encourage the generation of platelets in the bone marrow. The risk of blood clots can rise with the use of these medications.
4. Additional medications: Rituximab (Rituxan, Truxima) increases platelet count by lowering immune system response that is detrimental to platelets.
