Purpura
Purpura is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, or other causes. They measure 3–10 mm, whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.
Purpura is common with typhus and can be present with meningitis caused by meningococci or septicaemia. In particular, meningococcus, a Gram-negative diplococcus organism, releases endotoxin when it lyses. Endotoxin activates the Hageman factor, which causes disseminated intravascular coagulation. The DIC is what appears as a rash on the affected individual.
Classification
Purpura are a common and nonspecific medical sign; however, the underlying mechanism commonly involves one of:- Platelet disorders
- *Primary thrombocytopenic purpura
- *Secondary thrombocytopenic purpura
- *Post-transfusion purpura
- Vascular disorders
- *Microvascular injury, as seen in senile purpura, when blood vessels are more easily damaged
- *Hypertensive states
- *Deficient vascular support
- *Vasculitis, as in the case of Henoch–Schönlein purpura
- Coagulation disorders
- *Disseminated intravascular coagulation
- *Scurvy – defect in collagen synthesis due to lack of hydroxylation of procollagen results in weakened capillary walls and cells
- Meningococcemia
- Clumping fibrillary protein deposits caused by Amyloidosis
- Cocaine use with concomitant use of the one-time chemotherapy drug and now veterinary deworming agent levamisole can cause purpura of the ears, face, trunk, or extremities, sometimes needing reconstructive surgery. Levamisole is purportedly a common cutting agent.
- Decomposition of blood vessels including purpura is a symptom of acute radiation poisoning in excess of 2 Grays of radiation exposure. This is an uncommon cause in general, but is commonly seen in victims of nuclear disaster.