Difference between revisions of "Purpura"

(Purpuraal Rash)
 
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==Clinical Features==
 
==Clinical Features==
[[File:HSPVasc01.jpg| thumb|Palpable Purpura]]
 
[[File:PetechiaeSkin.png| thumb|Petechiae]]
 
 
''Both petechia and purpura do not blanch''
 
''Both petechia and purpura do not blanch''
 
*Purpura subdivided into:
 
*Purpura subdivided into:
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**>2mm of hemorrhage: ecchymoses
 
**>2mm of hemorrhage: ecchymoses
  
===[[Purpura]]l Rash===
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{{Purpura rash images}}
<gallery mode="packed">
 
File:Rocky Mountain Spotted Fever Rash.jpg|[[Rocky mountain spotted fever]]
 
File:Henoch-schonlein-purpura.jpg|[[Henoch-Schonlein purpura]]
 
</gallery>
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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==Evaluation==
 
==Evaluation==
{{Purpura rash images}}
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*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>
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[[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==
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*Depends on underlying etiology
  
 
==See Also==
 
==See Also==

Latest revision as of 21:21, 26 November 2020

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]

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