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Traumatic purpura in Adult
Other Resources UpToDate PubMed

Traumatic purpura in Adult

Contributors: Art Papier MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

It is important to note that some varieties of purpura may be a sign of emergency. Varieties dealt with here may be more prone to occur in the setting of low platelet count or bleeding diathesis.

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.

Codes

ICD10CM:
D69.2 – Other nonthrombocytopenic purpura

SNOMEDCT:
125667009 – Contusion

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Solar purpura (actinic purpura, senile purpura)
  • Steroid atrophy
  • Lichen sclerosus
  • Platelet disorders
  • Clotting disorders
  • Drug-induced non-palpable purpura
  • Immune thrombocytopenic purpura (ITP) – typically petechial
  • Thrombotic thrombocytopenic purpura (TTP) – typically petechial
  • Leukemia
  • Bacterial sepsis
  • Purpura fulminans
  • Autoerythrocyte sensitization
  • Acute meningococcemia
  • Cushing syndrome
  • Leukocytoclastic vasculitis – typically palpable purpura
  • Immunoglobulin A vasculitis – formerly Henoch-Schönlein purpura; typically palpable purpura
  • AL amyloidosis
  • Cryoglobulinemia
  • Cryofibrinogenemia
  • Disseminated intravascular coagulation (DIC)
  • Ecthyma gangrenosum
  • Scurvy

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:12/10/2020
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Traumatic purpura in Adult
A medical illustration showing key findings of Traumatic purpura : Erythema, Pressure exposure, External force exposure, Ecchymosis
Clinical image of Traumatic purpura - imageId=1587737. Click to open in gallery.  caption: 'An oval purpuric patch on the forehead secondary to suction.'
An oval purpuric patch on the forehead secondary to suction.
Copyright © 2024 VisualDx®. All rights reserved.