Traumatic purpura in Child
Purpura in the form of ecchymoses, or bruising, typically follows trauma, pressure, or other physical forces to the skin. Traumatic purpura is typically accidental, but factitial or self-induced cases occur frequently as well. Severe vomiting, coughing (Valsalva purpura), or other causes of increased venous pressure can cause subconjunctival hemorrhage or eyelid or periorbital petechiae or bruising. Suction to the skin can be self-induced (typical in children but also seen in adults). The most common cause of purpura is trauma from falls and blows to the skin. Bateman purpura (also known as solar, actinic, or senile purpura) is the term used to describe the ecchymoses of the forearms caused by minor or even imperceptible trauma to skin fragility, as seen in elderly and/or severely sun-damaged individuals. Large raised areas of purpura are considered hematomas. Chronically enlarging hematomas may be a sign of vascular malignancy, eg, angiosarcoma.
Ecchymoses around the mastoid bone and below the ear can be associated with head trauma and temporal bone fracture. Appropriate radiologic studies and neurological evaluation are required, as acute epidural hematoma may be associated. Ecchymoses in this location are often referred to as Battle's sign.
D69.2 – Other nonthrombocytopenic purpura
125667009 – Contusion
Differential Diagnosis & Pitfalls
- Steroid atrophy
- Lichen sclerosus
- Platelet disorders
- Clotting disorders
- Purpura in children, especially in an unusual location or with an unusual shape or pattern, must raise the question of child abuse.
- Drug-induced nonpalpable purpura
- Idiopathic thrombocytopenic purpura (ITP) – typically petechial
- Thrombotic thrombocytopenic purpura (TTP) – typically petechial
- Bacterial sepsis
- Purpura fulminans
- Gardner-Diamond syndrome
- Acute meningococcemia
- Cushing disease
- Vasculitis – typically palpable purpura
- Immunoglobulin A vasculitis – formerly Henoch-Schönlein purpura; typically palpable purpura
- Disseminated intravascular coagulation (DIC)
- Ecthyma gangrenosum