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 membranes on 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 a blood
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 they may also be related to
- bone marrow transplants
- stem cell transplants
- HIV infections
- hormone replacement
- estrogen therapies
- use of certain medications
You should always contact your doctor if you
notice any growths on or changes to your skin.
Pictures of purpura
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 normal platelet count.
The following could cause nonthrombocytopenic
- disorders that affect blood clotting
- certain congenital disorders, present at or
before birth, such as telangiectasia (fragile skin and connective tissue) or Ehlers-Danlos syndrome
- 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
- medications that prevent platelets from forming or that interfere with normal clotting
- drugs that cause the body to launch an immune reaction against platelets
- recent blood transfusions
- immune disorders such as idiopathic
- an infection in the bloodstream
- infection by HIV or Hepatitis C, or some viral infections (Epstein-Barr, rubella, cytomegalovirus)
- Rocky Mountain spotted fever (from a tick bite)
- systemic lupus erythematous
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
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 its own. Treatments include medications and sometimes a splenectomy, or
surgery to remove the spleen. 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. It usually 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.
If your purpura is causing severe bleeding, your
doctor may give you an intravenous medication called intravenous immunoglobulin
(IVIG). 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 the effect is usually only in the short term. It can cause
side effects such as headache, nausea, and fever.
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
- joint or muscle pain
- increased risk of blood clots
- acute respiratory distress syndrome
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. 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
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.
In rare cases, 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
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.
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 purpura.