Purpura: Difference between revisions
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==Background== | ==Background== | ||
{{Skin anatomy background images}} | |||
*Palpable [[petechiae]] and purpura are a result of either perivascular inflammation (vasculitis) or infection. | *Palpable [[petechiae]] and purpura are a result of either perivascular inflammation (vasculitis) or infection. | ||
*Non-palpable petechiae usually occur in low platelet states such as [[ITP]] and [[DIC]] | *Non-palpable petechiae usually occur in low platelet states such as [[ITP]] and [[DIC]] | ||
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==Clinical Features== | ==Clinical Features== | ||
''Both petechia and purpura do not blanch'' | ''Both petechia and purpura do not blanch'' | ||
*Purpura subdivided into: | *Purpura subdivided into: | ||
**<2mm of hemorrhage: petechiae | **<2mm of hemorrhage: petechiae | ||
**>2mm of hemorrhage: ecchymoses | **>2mm of hemorrhage: ecchymoses | ||
{{Purpura rash images}} | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*For children with fever and petechiae/purpura consider using the Barts Health NHS Trust guideline for workup. This guideline performed well head to head vs other guidelines in Petechiae in Children (PiC) study. <ref>Thomas et, al. Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study, The Lancet Infectious Diseases, 2020, https://doi.org/10.1016/S1473-3099(20)30474-6</ref> <ref>Tessa Davis. Petechiae in Children – the PiC Study, Don't Forget the Bubbles, 2020. Available at: https://doi.org/10.31440/DFTB.30782</ref> | |||
[[File:Management of children with fever and non-blanching rash.png|thumb|Fever and non-blanching rash in children algorithm from Barts Health NHS Trust guideline. Original image from https://dontforgetthebubbles.com/petechiae-in-children-study/]] | |||
==Management== | ==Management== | ||
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==Disposition== | ==Disposition== | ||
*Depends on underlying etiology | |||
==See Also== | ==See Also== | ||
*[[ | *[[General approach to rashes]] | ||
==References== | ==References== | ||
Latest revision as of 18:11, 11 December 2024
Background
- Palpable petechiae and purpura are a result of either perivascular inflammation (vasculitis) or infection.
- Non-palpable petechiae usually occur in low platelet states such as ITP and DIC
Rash Red Flags[1]
- Fever
- Toxic appearance
- Hypotension
- Mucosal lesions
- Severe pain
- Very old or young age
- Immunosuppressed
- New medication
Clinical Features
Both petechia and purpura do not blanch
- Purpura subdivided into:
- <2mm of hemorrhage: petechiae
- >2mm of hemorrhage: ecchymoses
Purpural Rash
Petechiae
Henoch-schonlein purpura (Palpable purpura)
Neonatal purpura fulminans
Differential Diagnosis
Petechiae/Purpura (by cause)
- Abnormal platelet count and/or coagulation
- Septicemia
- Idiopathic thrombocytopenic purpura (ITP)
- Hemolytic uremic syndrome
- Leukemia
- Coagulopathies (e.g. hemophilia)
- Henoch-Schonlein Purpura (HSP)
- Acute hemorrhagic edema of infancy (AHEI)
- Hypersensitivity vasculitis
- Primary vasculitides
- Wegener's
- Microscopic polyangiitis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
- Secondary vasculitides
- Trauma
Petechiae/Purpura (by findings)
- Febrile, toxic
- Palpable
- Meningococcemia
- Disseminated gonococcal infection
- Endocarditis
- Rocky mountain spotted fever
- HSP
- Non-palpable
- Palpable
- Afebrile, nontoxic
- Palpable
- Autoimmune vasculitis
- Non-palpable
- Palpable
Evaluation
- For children with fever and petechiae/purpura consider using the Barts Health NHS Trust guideline for workup. This guideline performed well head to head vs other guidelines in Petechiae in Children (PiC) study. [2] [3]
Fever and non-blanching rash in children algorithm from Barts Health NHS Trust guideline. Original image from https://dontforgetthebubbles.com/petechiae-in-children-study/
Management
- Management directed by underlying condition
Disposition
- Depends on underlying etiology
See Also
References
- ↑ Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.
- ↑ Thomas et, al. Validating clinical practice guidelines for the management of children with non-blanching rashes in the UK (PiC): a prospective, multicentre cohort study, The Lancet Infectious Diseases, 2020, https://doi.org/10.1016/S1473-3099(20)30474-6
- ↑ Tessa Davis. Petechiae in Children – the PiC Study, Don't Forget the Bubbles, 2020. Available at: https://doi.org/10.31440/DFTB.30782