Capillaritis (also known as benign pigmented purpura and pigmented purpuric dermatosis [PPD]) is a dermatologic condition resulting from inflammation and disruption of papillary dermal vessels, with subsequent extravasation of red blood cells. The subtypes of capillaritis differ in both demographics and clinical presentation, with overlap noted. Lesions are characterized by cayenne-pepper-like petechiae, purpura, and golden-brown pigmentation. While classically macular, with more intense inflammation, papular lichenoid or eczematous changes may also be exhibited.

Capillaritis in its most common form is typically asymptomatic, but in some types, it may be pruritic, mildly painful, or may burn. It is usually chronic with intermittent exacerbations and remissions. There is no geographic or hereditary predilection. Atypical presentations of capillaritis not consistent with the following classification should raise the suspicion of some other underlying condition.

The well-described PPDs are:

Classic forms

• Schamberg disease – the most common manifestation of PPD; affects middle-aged to older men
• Purpura annularis telangiectodes (Majocchi disease) – uncommon; affects adolescents to young adults; most common in females
• Eczematid-like purpura of Doucas and Kapetanakis – a more inflammatory and less common subtype of Schamberg disease
• Pigmented purpuric lichenoid dermatosis of Gougerot and Blum – rare; most common in middle-aged men
• Lichen aureus – most common in young men

Other forms

• Linear pigmented purpura – uncommon; most commonly affects children and adolescents
• Granulomatous pigmented purpura – very rare; most common in middle-aged to older adults and Asian individuals
• Golfer's vasculitis (exercise-induced vasculitis; hiker's rash) – relatively common but underrecognized; not reported in children

Development or worsening of preexisting capillaritis has been associated with venous hypertension, increased capillary fragility, gravity, exercise, and focal infections. Capillaritis has been reported as a rare sequela of SARS-CoV-2 vaccination, both primary and booster.

While PPD is uncommonly seen in children, all the classic subtypes along with linear pigmented purpura have been reported in the pediatric population, with Schamberg disease being the most common.