Purpura: Difference between revisions

(Created page with "==Differential Diagnosis== ===Purpura=== *Abnormal platelet count and/or coagulation studies **Septicemia **Immune thrombocytopenia (ITP) **hemolytic uremic syndrome **leukemi...")
 
 
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==Background==
{{Skin anatomy background images}}
*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}}
==Clinical Features==
''Both petechia and purpura do not blanch''
*Purpura subdivided into:
**<2mm of hemorrhage: petechiae
**>2mm of hemorrhage: ecchymoses
{{Purpura rash images}}
==Differential Diagnosis==
==Differential Diagnosis==
===Purpura===
{{Purpura DDX}}
*Abnormal platelet count and/or coagulation studies
 
**Septicemia
{{Purpura DDX by findings}}
**Immune thrombocytopenia (ITP)
 
**hemolytic uremic syndrome
==Evaluation==
**leukemia
*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>
**coagulopathies (eg, hemophilia)
[[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/]]
*Abnormal platelet count and/or coagulation studies
 
**[[HSP]]
==Management==
**Acute hemorrhagic edema of infancy (AHEI)
*Management directed by underlying condition
*Hypersensitivity vasculitis
 
*Primary vasculitides
==Disposition==
**Wegener's
*Depends on underlying etiology
**Microscopic polyangiitis
 
**Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
==See Also==
*Secondary vasculitides
*[[General approach to rashes]]
**Connective tissue disorder (eg, systemic lupus erythematosus [SLE])
 
**Infectious disease (eg, hepatitis B or C)
==References==
<references/>
 
[[Category:Dermatology]]
[[Category:Symptoms]]

Latest revision as of 18:11, 11 December 2024

Background

Normal dermal anatomy.
  • 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]

Clinical Features

Both petechia and purpura do not blanch

  • Purpura subdivided into:
    • <2mm of hemorrhage: petechiae
    • >2mm of hemorrhage: ecchymoses

Purpural Rash

Differential Diagnosis

Petechiae/Purpura (by cause)

Petechiae/Purpura (by findings)

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

  1. ↑ Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.
  2. ↑ 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
  3. ↑ Tessa Davis. Petechiae in Children – the PiC Study, Don't Forget the Bubbles, 2020. Available at: https://doi.org/10.31440/DFTB.30782
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