Case Report: Bilateral Progressive Leg Atrophic Skin Lesions: A Case Report of Pigmented Purpura
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- Category: Vol. 82, December 2014
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Case Report: Bilateral Progressive Leg Atrophic Skin Lesions: A Case Report of Pigmented Purpura, AZIZ A.A. AL-SOHAIMI, HASAN S. AL-GHAMDI and SADIQ A. ARIF
Abstract
Background: Pigmented purpura constitutes a group of dermatoses of unknown etiology that may persist for months or years with frequent recurrences. They are characterized by extravasation of erythrocytes in the skin with marked hemo-siderin deposition.
Case Report: We report a type 1 diabetic female case who presented with progressive bilateral painless atrophic skin lesions on both legs for the past 5 years. There were no systemic complaints or any history of other skin problems, no history of trauma or injury or applying any topical medi-cations, or the use of any chemical or herbal compounds. There was a positive family history for diabetes, but there was no family history of any similar skin lesions. Skin exam-ination showed discrete, non-clustered, slightly atrophic, annular dark brown macules and patches on both legs ranging in size from 1-3cm that were scattered and symmetrically distributed, mainly over the anterior aspect of both legs. Laboratory investigations included complete blood count, fasting blood sugar, liver and kidney function tests, hepatitis serology, which revealed normal findings. Perls stain of skin biopsy for iron staining, which demonstrated the deposition of hemosiderin in the dermis and lymphocytic perivascular infiltration in the papillary dermis. So, the condition was diagnosed as a case of pigmented purpuric dermatitis. The patient received pentoxifylline (400mg bid) and ascorbic acid (500mg od). Improvement started to occur after 2 months. On the third visit, her skin lesions almost disappeared.
Conclusion: Pigmented purpura is a chronic progressive skin disease. Oral treatment with ascorbic acid and pentoxi-fylline for 2-3 months shows favorable response in several reported cases.
Recommendations: General practitioners and family phy-sicians should be trained to spot and identify the characteristic skin lesions.