What Is Purpura?
Purpura, also called blood spots or skin
hemorrhages, refers to purple-colored spots that are most recognizable on the
skin. The spots could also be located on organs or mucous membranes, including
the inside of the mouth.
Purpura occurs when small blood vessels burst, causing blood to
pool under the skin. This can create purple spots on the skin that range in
size from small dots to large patches. Purpura spots are generally benign, but
may indicate a more serious medical condition, such as blood clotting disorders.
Sometimes, low platelet levels can cause excessive bruising and
bleeding. Platelets are the cells that help your blood clot. Low platelet
levels may be inherited or genetic, but also may be related to recent:
- bone marrow transplants
- stem cell transplants
- HIV infections
- hormone replacement
- estrogen therapies
- certain medications
You should always contact your doctor if you notice any growths
or changes on your skin.
What Causes Purpura?
There are two kinds of purpura: nonthrombocytopenic and
thrombocytopenic. Nonthrombocytopenic means that you have normal platelet
levels in your blood. Thrombocytopenic means that you have a
lower-than-average platelet count.
The following could cause nonthrombocytopenic purpura:
- disorders that affect blood clotting
- certain congenital disorders (present at or
before birth) such as rubella and cytomegalovirus
- certain medications, including steroids and
those that affect platelet function
- weak blood vessels
- inflammation in the blood vessels
- scurvy, or a severe lack of vitamin C
The following could cause thrombocytopenic purpura:
- medications that prevent platelets from forming
- recent blood transfusions
- immune disorders such as idiopathic
- infection in the bloodstream
How Is Purpura Diagnosed?
Your doctor will examine your skin to diagnose purpura. They may
ask about your family and personal health history, such as when the spots first
appeared. Your doctor may also perform a biopsy of the skin in addition to
blood and platelet count tests.
These tests will help assess whether or not your purpura is a
result of a more serious condition, such as a platelet or blood disorder. The
levels of platelets can help identify the cause of the purpura and will help
your doctor determine the best method of treatment.
Purpura can affect both children and adults. Children may develop
it after a viral infection and can usually recover completely without any
intervention. Most children with thrombocyotopenic purpura fully recover within
several months of the disorder’s onset. However, in adults purpura is usually
chronic and requires treatment to help manage symptoms and keep platelet counts
within a healthy range.
How Is Purpura Treated?
The type of treatment your doctor will prescribe depends on the
cause of your purpura. Adults diagnosed with mild thrombocyotopenic purpura may
recover without any intervention.
You will need treatment if the disorder doesn’t go away on it’s
own. Treatments include medications and sometimes surgery to remove the spleen
(splenectomy). You may also be asked to stop taking medications that impair
platelet function, such as aspirin, blood thinners, and ibuprofen.
Your doctor may start you on a corticosteroid medication, which
can help increase your platelet count by decreasing the activity of your immune
system. Usually it takes about two to six weeks for your platelet count to
return to a safe level. When it does, your doctor will discontinue the drug.
It’s important to talk to your doctor about the risks of taking
corticosteroids for long periods of time. Doing so can cause serious side
effects, such as weight gain, cataracts, and bone loss.
Your doctor may give you an intravenous medication called intravenous
immunoglobulin (IVIG) if your purpura is causing severe bleeding. They may also
give you IVIG if you need to increase your platelet count rapidly before
surgery. This treatment is usually effective in increasing your platelet count
but this effect is usually only short-term. It can cause side effects such as
headache, nausea, and fever.
Other Drug Therapies
The latest drugs used to treat purpura are romiplostim (Nplate)
and eltrombopag (Promacta). These medications cause bone
marrow to produce more platelets, which reduces the risk of bruising and
bleeding. Potential side effects include:
- joint or muscle pain
- increased risk of blood clots
Biologic therapy, such as the drug rituximad (Rituxan), can help decrease the immune system
response. It’s mostly used to treat patients with severe thrombocyotopenic
purpura and patients for whom corticosteroid treatment isn’t effective. Some
side effects may include:
- low blood pressure
- sore throat
If medications aren’t effective in treating your purpura, your
doctor may recommend a splenectomy. Removing the spleen is a fast way of
increasing your platelet count. This is because the spleen is the main body
part responsible for eliminating platelets.
However, splenectomies aren’t effective in everyone. The surgery
also comes with risks, such as a permanently increased risk of infection. In
emergencies, when purpura causes extreme bleeding, hospitals will perform
transfusions of platelet concentrates, corticosteroids, and immunoglobulin.
Once treatment is started, your doctor will monitor your platelet
count to help determine whether or not it’s effective. They may change your
treatment depending on its efficacy.
What Is the Outlook for Purpura?
The outlook for purpura depends on the underlying condition
causing it. When your doctor confirms a diagnosis, they’ll discuss treatment
options and the long-term outlook for your condition.
Rarely, a case of thrombocytopenic purpura that’s left untreated
may cause a person to develop excessive bleeding in some part of their body. Excessive
bleeding in the brain can lead to a fatal brain hemorrhage.
People who start treatment right away or have a mild case often
make a full recovery. However, purpura can become chronic in severe cases or
when treatment is delayed. You should see your doctor as soon as possible if
you suspect you have purpura.
Living with Purpura
Sometimes the spots from purpura do not go away completely.
Certain medications and activities can make these spots worse. To reduce your
risk of forming new spots or making spots worse, you should avoid medications
that reduce platelet count. These medications include aspirin and ibuprofen.
You should also choose low-impact activities over high-impact activities. This can
increase your risks of injury, bruising, and bleeding.
It can be difficult to cope with having a chronic condition.
Reaching out and talking with others who have the disorder can help. Check
online for support groups that can connect you with others who have