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Purpura

Blood spots; Skin hemorrhages

Purpura is purple-colored spots and patches that occur on the skin, and in mucus membranes, including the lining of the mouth.

Considerations

Purpura occurs when small blood vessels leak blood under the skin.

Purpura measure between 4 and 10 mm (millimeters) in diameter. When purpura spots are less than 4 mm in diameter, they are called petechiae. Purpura spots larger than 1 cm (centimeter) are called ecchymoses.

Platelets help the blood clot. A person with purpura may have normal platelet counts (non-thrombocytopenic purpuras) or low platelet counts (thrombocytopenic purpuras).

Causes

Non-thrombocytopenic purpuras may be due to:

  • Amyloidosis (disorder in which abnormal proteins build up in tissues and organs)
  • Blood clotting disorders
  • Congenital cytomegalovirus (condition in which an infant is infected with a virus called cytomegalovirus before birth)
  • Congenital rubella syndrome
  • Drugs that affect platelet function or clotting factors
  • Fragile blood vessels seen in older people (senile purpura)
  • Hemangioma (abnormal buildup of blood vessels in the skin or internal organs)
  • Inflammation of the blood vessels (vasculitis), such as Henoch-Schönlein purpura, which causes a raised type of purpura
  • Pressure changes that occur during vaginal childbirth
  • Scurvy (vitamin C deficiency)
  • Steroid use
  • Certain infections
  • Injury

Thrombocytopenic purpura may be due to:

When to Contact a Medical Professional

Call your health care provider for an appointment if you have signs of purpura.

What to Expect at Your Office Visit

The provider will examine your skin and ask about your medical history and symptoms, including:

  • Is this the first time you have had such spots?
  • When did they develop?
  • What color are they?
  • Do they look like bruises?
  • What medicines do you take?
  • What other medical problems have you had?
  • Does anyone in your family have similar spots?
  • What other symptoms do you have?

A skin biopsy may be done. Blood and urine tests may be ordered to determine the cause of the purpura.

References

Habif TP. Principles of diagnosis and anatomy. In: Habif TP, ed. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 1.

Kitchens CS. Purpura and other hematovascular disorders. In: Kitchens CS, Kessler CM, Konkle BA, Streiff MB, Garcia DA, eds. Consultative Hemostasis and Thrombosis. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 10.

  • Henoch-Schonlein purpura on the lower legs

    Henoch-Schonlein purpura on the lower legs - illustration

    Henoch-Schonlein Purpura. This disorder usually presents with red to purple bumps on the legs, often accompanied by aching in the joints and fever. This condition follows an infection and usually resolves without treatment. Skin lesions most commonly occur below the knee but may also be seen on the thigh, buttocks, and rarely on the arms.

    Henoch-Schonlein purpura on the lower legs

    illustration

  • Henoch-Schonlein purpura on an infant's foot

    Henoch-Schonlein purpura on an infant's foot - illustration

    Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

    Henoch-Schonlein purpura on an infant's foot

    illustration

  • Henoch-Schonlein purpura on an infant's legs

    Henoch-Schonlein purpura on an infant's legs - illustration

    Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

    Henoch-Schonlein purpura on an infant's legs

    illustration

  • Henoch-Schonlein purpura on an infant's legs

    Henoch-Schonlein purpura on an infant's legs - illustration

    Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

    Henoch-Schonlein purpura on an infant's legs

    illustration

  • Henoch-Schonlein purpura on the legs

    Henoch-Schonlein purpura on the legs - illustration

    Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

    Henoch-Schonlein purpura on the legs

    illustration

  • Meningococcemia on the calves

    Meningococcemia on the calves - illustration

    Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) may occur. The tissue in areas may die (become necrotic or gangrenous). If the person survives, the areas heal with scarring.

    Meningococcemia on the calves

    illustration

  • Meningococcemia on the leg

    Meningococcemia on the leg - illustration

    Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. There is usually bleeding into the skin (petechiae and purpura), and the tissue in these areas may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring. This picture demonstrates more hemorrhage and little tissue death.

    Meningococcemia on the leg

    illustration

  • Rocky mountain spotted fever on the foot

    Rocky mountain spotted fever on the foot - illustration

    Rocky Mountain spotted fever is caused by the organism Rickettsia rickettsii and is transmitted by a tick bite. It is a serious infection that produces a classical rash in about 90% of infected individuals. This is the typical appearance of the rash. There are many symptoms that affect the entire body (systemic).

    Rocky mountain spotted fever on the foot

    illustration

  • Meningococcemia associated purpura

    Meningococcemia associated purpura - illustration

    Meningococcemia is a life-threatening infection that occurs when the bacteria, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) typically occurs and the tissue may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring.

    Meningococcemia associated purpura

    illustration

    • Henoch-Schonlein purpura on the lower legs

      Henoch-Schonlein purpura on the lower legs - illustration

      Henoch-Schonlein Purpura. This disorder usually presents with red to purple bumps on the legs, often accompanied by aching in the joints and fever. This condition follows an infection and usually resolves without treatment. Skin lesions most commonly occur below the knee but may also be seen on the thigh, buttocks, and rarely on the arms.

      Henoch-Schonlein purpura on the lower legs

      illustration

    • Henoch-Schonlein purpura on an infant's foot

      Henoch-Schonlein purpura on an infant's foot - illustration

      Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

      Henoch-Schonlein purpura on an infant's foot

      illustration

    • Henoch-Schonlein purpura on an infant's legs

      Henoch-Schonlein purpura on an infant's legs - illustration

      Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

      Henoch-Schonlein purpura on an infant's legs

      illustration

    • Henoch-Schonlein purpura on an infant's legs

      Henoch-Schonlein purpura on an infant's legs - illustration

      Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

      Henoch-Schonlein purpura on an infant's legs

      illustration

    • Henoch-Schonlein purpura on the legs

      Henoch-Schonlein purpura on the legs - illustration

      Henoch-Schonlein purpura is more commonly seen in children than adults and often occurs after an upper respiratory infection. It causes skin rashes that bleed into the skin (petechiae and purpura). Bleeding may also occur from the gastrointestinal tract and kidneys.

      Henoch-Schonlein purpura on the legs

      illustration

    • Meningococcemia on the calves

      Meningococcemia on the calves - illustration

      Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) may occur. The tissue in areas may die (become necrotic or gangrenous). If the person survives, the areas heal with scarring.

      Meningococcemia on the calves

      illustration

    • Meningococcemia on the leg

      Meningococcemia on the leg - illustration

      Meningococcemia is a life-threatening infection that occurs when the meningococcus, Neisseria meningitidis, invades the blood stream. There is usually bleeding into the skin (petechiae and purpura), and the tissue in these areas may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring. This picture demonstrates more hemorrhage and little tissue death.

      Meningococcemia on the leg

      illustration

    • Rocky mountain spotted fever on the foot

      Rocky mountain spotted fever on the foot - illustration

      Rocky Mountain spotted fever is caused by the organism Rickettsia rickettsii and is transmitted by a tick bite. It is a serious infection that produces a classical rash in about 90% of infected individuals. This is the typical appearance of the rash. There are many symptoms that affect the entire body (systemic).

      Rocky mountain spotted fever on the foot

      illustration

    • Meningococcemia associated purpura

      Meningococcemia associated purpura - illustration

      Meningococcemia is a life-threatening infection that occurs when the bacteria, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) typically occurs and the tissue may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring.

      Meningococcemia associated purpura

      illustration

     

    Review Date: 4/16/2019

    Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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