Purpura

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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151 Purpura

Instruction

Examine this patient’s skin.

Salient features

History

• Take a drug history: steroids, anticoagulants, carbimazole, phenylbutazone, chloramphenicol, gold salts

• Age (senile purpura)

• History of chronic liver disease

• History of mouth ulcers (severe neutropenia).

Examination

• Small circumscribed bleeding into the skin, purpura, or larger lesions, bruises or ecchymoses (Fig. 151.1). Lesions begin as 1–3 mm papules, which increase in size and become palpable. They may coalesce to form plaques; in some instances, they may ulcerate.

image

Fig. 151.1 Purpura.

Proceed as follows:

• Look for an underlying cause

• Comment on the patient’s age: consider senile purpura

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