SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (16)

Drug-induced non-palpable purpura in Adult
Other Resources UpToDate PubMed

Drug-induced non-palpable purpura in Adult

Contributors: Michael D. Tharp MD, Neil Shear MD
Other Resources UpToDate PubMed


Petechiae and non-palpable purpura (ecchymoses) secondary to medications occur as a result of hemorrhage into the skin. Medications that cause thrombocytopenia or alter platelet function manifest with petechiae and ecchymoses. Chemotherapeutic agents can cause generalized bone marrow suppression leading to thrombocytopenia. Bleomycin has been reported to cause endothelial damage and leakage resulting in purpura.

Uncommonly, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have been associated with purpuric skin lesions on the lower extremities, including purpuric macules or papules with confluent plaques, sometimes in an annular configuration; non-follicular purpuric pustules; and xerotic purpuric lesions. See also EGFR inhibitor-induced eruption.

Drug-induced thrombotic thrombocytopenic purpura (TTP) may occur secondary to medication use. It is a life-threatening, multisystem disease. There is strong literature evidence of ticlopidine as a trigger of TTP. Other triggers of TTP frequently reported include interferon alpha (IFN-alpha) therapy, cyclosporine, quinine, and clopidogrel.


L27.1 – Localized skin eruption due to drugs and medicaments taken internally

109957002 – Drug-induced purpura

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

A drug-induced etiology is a diagnosis of exclusion.
  • If lesions are palpable, consider Leukocytoclastic vasculitis.
  • Capillaritis usually has orange-brown color to the macules.
  • Bacterial sepsis typically manifests with symptoms and signs of toxicity.
  • Adult physical abuse must be considered if lesions follow a pattern to suggest external insult.
  • Viral exanthem
  • Purpura fulminans
  • Acute meningococcemia
  • Rocky Mountain spotted fever
  • Ehrlichiosis
  • Immune thrombocytopenic purpura
  • Disseminated intravascular coagulation
  • Scarlet fever
  • Q fever

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Updated:10/12/2017
Copyright © 2024 VisualDx®. All rights reserved.
Drug-induced non-palpable purpura in Adult
A medical illustration showing key findings of Drug-induced non-palpable purpura : Cayenne pepper like purpura, Erythema, Scattered many, Symmetric extremities distribution, Ecchymosis
Clinical image of Drug-induced non-palpable purpura - imageId=369027. Click to open in gallery.  caption: 'Showers of discrete and confluent petechiae and purpura on the foot.'
Showers of discrete and confluent petechiae and purpura on the foot.
Copyright © 2024 VisualDx®. All rights reserved.