Solar Purpura

Diagnosis: Solar Purpura

Clinical History

Purple ecchymoses on dorsal forearms and hands in elderly patients. No underlying coagulopathy. Chronic sun damage. Anticoagulant/corticosteroid use.

Treatment

Reassurance — benign condition. Sun protection. Topical retinoids may improve dermal thickness. Arnica-based topicals (limited evidence). Review anticoagulant necessity.

Differential Diagnosis

• Thrombocytopenic purpura • Anticoagulant-induced purpura • Vasculitis • Steroid-induced purpura • Pigmented purpuric dermatosis • Scurvy • Senile purpura

Key Learnings

• Also called actinic purpura or senile purpura (Bateman purpura) • Dark purple ecchymoses on sun-damaged skin of forearms and dorsal hands • Caused by dermal atrophy and loss of perivascular connective tissue support from chronic UV exposure and aging • NOT a coagulation disorder — platelet count and coagulation studies are normal • Worsened by: anticoagulants, antiplatelet agents, topical/systemic corticosteroids • Self-limited — heals with residual brown discoloration (hemosiderin) • No treatment needed — cosmetic concern

Tags: kodachrome, Solar Purpura