The word “purpura” is reminiscent of “purple” and for good reason: it is a dark red stain, which appears when blood comes out of the vessels and stagnates under the skin – in medical language, we speak of a “Extravasation of blood in the dermis”.
Purpura can affect both adults and children, and depending on how it looks, it can lead to different diagnoses – the most urgent being, of course, purpura fulminans.
Purpura is an alarm signal that should not be overlooked: in case of doubt (and especially when the victim is a child), a call to the SAMU (15) or a visit to the Emergency Room is essential!
Sources:
Annals of Dermatology and Venereology
French Society of Emergency Medicine
How do you recognize the symptoms of purpura?
Bacterial infection, blood vessel abnormality, blood problem … Purpura can be linked to a large number of causes. To recognize a purpura, however, there is a very specific symptom: one (or more) red / purplish spots on the skin that do not turn white when pressed – unlike erythema or angioma.
Good to know : to test if it is a purpura or another dermatological disorder, take a clear glass and press the bottom of the glass on the stain. If it doesn’t go away, it’s probably purpura.
In general, these spots extend on the lower limbs – the legs, the feet … They do not itch, they are not raised (the skin remains smooth) and can have several aspects: small red dots (one speaks then of petechial purpura, it is the most frequent), purpura “layers” of which the contours are ill-defined (it is the ecchymotic purpura) or even reddish streaks at the level of the flexion folds (purpura in vibices, more rare).
Purpura fulminans, a life-threatening emergency
Cause: purpura fulminans indicates sepsis, which is a generalized infection of the blood and various organs. In 80% of cases, the culprit is meningococcus, this bacterium which is particularly responsible for meningitis. Purpura fulminans can affect both children and adults.
Symptoms. There is a petechial or ecchymotic purpura, associated with fever or hypothermia (hands and feet are cold), aches and / or stiffness (especially in the neck), a “bad look », Or even drowsiness and / or discomfort in the light.
Processing. This is a vital emergency: a call to the SAMU (15) is essential! Even before being transported to the hospital (first to the Emergency Department and then to the intensive care unit), the patient will receive a first dose of an antibiotic treatment appropriate for meningococcal infections (ceftriaxone or amoxicillin).
Good to know: there is another case where purpura is a vital emergency: purpura with hemorrhagic syndrome. There is a purpura associated with mucous or retinal hemorrhages (understand: blood in the eye, in the mouth, in the genitals …) and headaches (migraine type). Here again, it is essential to go quickly to the Emergency Department or to call the SAMU (15) because there is a risk of intracranial hemorrhage.
Thrombocytopenic purpura, a blood abnormality
Cause: Thrombocytopenic purpura is linked to a decrease in the number of platelets in the blood. However, the role of platelets is precisely to prevent bleeding. Thrombocytopenic purpura can be central (when the spots extend all over the body or almost) or peripheral (when they are localized in a specific area).
Symptoms : There is a petechial or ecchymotic purpura associated with hemorrhages in the mucous membranes (bleeding gums, “blood bubbles” in the mouth, bleeding nose, etc.) and / or “bruises”. In children, thrombocytopenic purpura often follows an infectious episode of the viral type (chickenpox, mononucleosis … which occurred 2 to 3 weeks earlier).
Processing : In the event of minor to moderate bleeding (light bleeding from the mucous membranes, little extensive purpura), a visit to the attending physician is recommended promptly. In the event of moderate to severe bleeding (with headaches, pain, drowsiness …), a call to the SAMU (15) is essential!
Good to know: Immunological (or idiopathic) thrombocytopenic purpura, also called “ITP”, is an autoimmune blood disease. In patients with ITP, an imbalance in the immune system results in the production of antibodies that fight the patient’s own platelets.
Each year, the incidence is estimated at between 5 and 10 cases per 100,000 inhabitants. In children, the disease (mild) heals in 60 to 70% of cases within a few weeks. On the other hand, in adults, it becomes chronic in 2 out of 3 cases, and comes back regularly in flare-ups.
Vascular purpura, a fragility of the blood vessels
Causes: vascular purpura results from a fragility of one (or more) blood vessels: because of a bacteria or the undesirable effect of a drug, the “pipe” in which the blood circulates is less tight, this which causes a mini-hemorrhage under the skin.
Symptoms : We observe a petechial purpura associated with small dermatological lesions (pimples, “bubbles”, marbling …). In parallel, one can notice abdominal pain, joint pain, Raynaud’s phenomenon (that is to say: cold extremities) and / or polyneuritis (tingling, numbness, sensory disturbances …).
Processing : Additional medical examinations are necessary and must be carried out quickly. Indeed, many factors can lead to vascular purpura: hepatitis C, bacterial, viral or parasitic infections, blood diseases … However, in 30 to 50% of cases, no cause is identified.
Good to know : the most common vascular purpura is rheumatoid purpura, also known as Schœnlein-Henoch disease. It is characterized by petechial or ecchymotic purpura, joint pain and stomach pain (with colic and / or vomiting).
The disease most often starts after an episode of infection of the respiratory system. While rheumatoid purpura peaks in frequency between the ages of 4 and 7, this disease can also affect adults. Healing usually occurs within 2 to 3 weeks, complications are rare.
