Summary: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. When the size of the discolorization is >2-3 cm it is generally called Ecchymoses (ECCHYMOSIS).

Top Publications

  1. Shtalrid M, Shvidel L, Vorst E, Weinmann E, Berrebi A, Sigler E. Post-transfusion purpura: a challenging diagnosis. Isr Med Assoc J. 2006;8:672-4 pubmed
    Post-transfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused by alloimunization to human platelet specific antigens following a blood component transfusion...
  2. Iwata K, Arinuma Y, Nakayama H, Nogi S, Futami H, Takaoka H, et al. An autopsy case of necrotizing fasciitis with rapidly progressive purpura caused by hemolytic streptococcal infection in a patient with rheumatoid arthritis. Mod Rheumatol. 2011;21:669-72 pubmed publisher
    A 77-year-old woman with rheumatoid arthritis was admitted as an emergency because of pain in the right leg with purpura. She was diagnosed with severe cellulitis and sepsis and started on intravenous antibiotics; however, the lesion ..
  3. Edmonson M, Riedesel E, Williams G, DeMuri G. Generalized petechial rashes in children during a parvovirus B19 outbreak. Pediatrics. 2010;125:e787-92 pubmed publisher
    ..Associated clinical features, hematologic abnormalities, and serologic test results are consistent with a viremia-associated illness that is distinct from and occasionally followed by erythema infectiosum. ..
  4. Giordano C, Viscomi C, Orlandi M, Papoff P, Spalice A, Burlina A, et al. Morphologic evidence of diffuse vascular damage in human and in the experimental model of ethylmalonic encephalopathy. J Inherit Metab Dis. 2012;35:451-8 pubmed publisher
  5. Nayak K, Spencer N, Shenoy M, Rubithon J, Coad N, Logan S. How useful is the presence of petechiae in distinguishing non-accidental from accidental injury?. Child Abuse Negl. 2006;30:549-55 pubmed
  6. Chung C, Tumeh P, Birnbaum R, Tan B, Sharp L, McCoy E, et al. Characteristic purpura of the ears, vasculitis, and neutropenia--a potential public health epidemic associated with levamisole-adulterated cocaine. J Am Acad Dermatol. 2011;65:722-725.e2 pubmed publisher
    ..San Francisco recently reported two patients in the online Journal of the American Academy of Dermatology with purpura presumably induced by levamisole in contaminated cocaine...
  7. Walsh N, Green P, Burlingame R, Pasternak S, Hanly J. Cocaine-related retiform purpura: evidence to incriminate the adulterant, levamisole. J Cutan Pathol. 2010;37:1212-9 pubmed publisher
    ..Published cases of retiform purpura related to cocaine use are rare and an etiologic role for levamisole, a common adulterant of cocaine, has been ..
  8. Fretzayas A, Douros K, Moustaki M, Nicolaidou P. Papular-purpuric gloves and socks syndrome in children and adolescents. Pediatr Infect Dis J. 2009;28:250-2 pubmed publisher
    ..The review of the literature yielded 25 cases of gloves and socks syndrome. Most patients were febrile and had acute PVB19 infection. ..
  9. Hashimoto H, Yuno T. Parvovirus B19-associated purpuric-petechial eruption. J Clin Virol. 2011;52:269-71 pubmed publisher
    ..Such multifaceted features can cause considerable confusion when making a diagnosis of purpuric eruption associated with PVB19...

More Information


  1. Brauer J, Mundi J, Chu J, Patel R, Meehan S, Greenspan A, et al. Progressive pigmentary purpura. Dermatol Online J. 2011;17:14 pubmed
    ..dermatitis with features of lymphocytic vasculitis; a diagnosis of exercise-induced progressive pigmentary purpura was made...
  2. Santonja C, Nieto González G, Santos Briz A, Gutiérrez Zufiaurre M, Cerroni L, Kutzner H, et al. Immunohistochemical detection of parvovirus B19 in "gloves and socks" papular purpuric syndrome: direct evidence for viral endothelial involvement. Report of three cases and review of the literature. Am J Dermatopathol. 2011;33:790-5 pubmed publisher
  3. Maat M, Buysse C, Emonts M, Spanjaard L, Joosten K, De Groot R, et al. Improved survival of children with sepsis and purpura: effects of age, gender, and era. Crit Care. 2007;11:R112 pubmed
    ..that might affect results of future case-control studies, we performed an analysis of children with sepsis and purpura admitted to the paediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital (Rotterdam, The ..
  4. Lee H, Chang S, Lee M, Choi J, Moon K. Systemic amyloidosis associated with multiple myeloma presenting as periorbital purpura. J Dermatol. 2008;35:371-2 pubmed publisher
  5. Magro C, Wang X. Cocaine-associated retiform purpura: a C5b-9-mediated microangiopathy syndrome associated with enhanced apoptosis and high levels of intercellular adhesion molecule-1 expression. Am J Dermatopathol. 2013;35:722-30 pubmed publisher
    Cocaine-associated retiform purpura is a recently described entity characterized by striking hemorrhagic necrosis involving areas of skin associated with administration of cocaine...
  6. Salluh J, Bozza F, Pinto T, Toscano L, Weller P, Soares M. Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?. Braz J Infect Dis. 2005;9:419-24 pubmed
    ..Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support...
  7. Geller L, Whang T, Mercer S, Phelps R. Retiform purpura: a new stigmata of illicit drug use?. Dermatol Online J. 2011;17:7 pubmed
    We report a 50-year-old woman who presented with a six-month history of recurrent retiform purpura of uncertain etiology. Laboratory findings included neutropenia, positive anticardiolipin IgM antibody, and a weakly positive p-ANCA...
  8. Di Meo I, Fagiolari G, Prelle A, Viscomi C, Zeviani M, Tiranti V. Chronic exposure to sulfide causes accelerated degradation of cytochrome c oxidase in ethylmalonic encephalopathy. Antioxid Redox Signal. 2011;15:353-62 pubmed publisher
  9. Edlich R, Cross C, Dahlstrom J, Long W. Modern concepts of the diagnosis and treatment of purpura fulminans. J Environ Pathol Toxicol Oncol. 2008;27:191-6 pubmed
    b>Purpura fulminans is a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin that is rapidly progressive and accompanied by vascular collapse and disseminated intravascular coagulation...
  10. Ribeiro L, Rodrigues Junior E, Silva M, Takiuchi A, Fontes C. [Purpura in patient with disseminated strongiloidiasis]. Rev Soc Bras Med Trop. 2005;38:255-7 pubmed
    ..We present a case of an immunosuppressed man that developed disseminated strongyloidiasis with extensive purpura.
  11. McGovern T, Bennion S. Palmar purpura: an atypical presentation of childhood dermatitis herpetiformis. Pediatr Dermatol. 1994;11:319-22 pubmed
    ..All lesions and GSE symptoms resolved with dapsone and a gluten-free diet. Our purpose is to illustrate an unusual presentation of pediatric DH. ..
  12. Reddy T, Myers J. Syndrome of inappropriate secretion of antidiuretic hormone and nonpalpable purpura in a woman with Strongyloides stercoralis hyperinfection. Am J Med Sci. 2003;325:288-91 pubmed
  13. Ito Y, Arita M, Kumagai S, Takei R, Noyama M, Tokioka F, et al. Diffuse Alveolar Hemorrhage in IgA Vasculitis with an Atypical Presentation. Intern Med. 2017;: pubmed publisher
    IgA vasculitis (IgAV) commonly occurs in young children, who present with a tetrad of purpura, abdominal pain, arthralgia and nephritis. Diffuse alveolar hemorrhage (DAH) is a rare complication of IgAV...
  14. Buscatti I, Casella B, Aikawa N, Watanabe A, Farhat S, Campos L, et al. Correction to: Henoch-Schönlein purpura nephritis: initial risk factors and outcomes in a Latin American tertiary center. Clin Rheumatol. 2018;37:1325 pubmed publisher
    ..One of the author's name on this article was incorrectly spelled as "Sylvia C. L. Fahrat" . The correct spelling is "Sylvia C. L. Farhat" and is now presented correctly in this article. The original article has been corrected. ..
  15. Thomas E, John M, Bhatia A. Cutaneous manifestations of dengue viral infection in Punjab (north India). Int J Dermatol. 2007;46:715-9 pubmed
    ..As a significant proportion of patients showed cutaneous features, these manifestations, together with simple laboratory tests, will be helpful in the early diagnosis of dengue viral infection. ..
  16. Arch E, Schaefer J, Dahiya A. Cutaneous manifestation of disseminated strongyloidiasis in a patient coinfected with HTLV-I. Dermatol Online J. 2008;14:6 pubmed
    ..Recognition of the cutaneous manifestations of disseminated disease can facilitate diagnosis and implementation of appropriate therapy. ..
  17. Tian M, Liu S, Li J, Shu X. [Hypertension and intermittent convulsions for one month in a school-age child]. Zhongguo Dang Dai Er Ke Za Zhi. 2017;19:816-819 pubmed
    ..who had involvements of multiple systems after excluding common vasculitis, such as Kawasaki disease and Henoch-Schönlein purpura. Biopsy and angiography should be performed as early as possible for timely diagnosis and treatment.
  18. Kinoshita Y, Mayumi N, Inaba M, Igarashi T, Katagiri I, Kawana S. Elevated levels of antibodies against phosphatidylserine/prothrombin complex and/or cardiolipin associated with infection and recurrent purpura in a child: a forme fruste of antiphospholipid syndrome?. Dermatol Online J. 2015;21: pubmed
    ..b>Purpura appeared repeatedly in a female infant starting from the age of 6 months and following episodes of upper ..
  19. Garcias Ladaria J, Pérez Ferriols A, Ortega Garcia P, Diago M. Management of refractory telaprevir-induced dermatitis using oral corticosteroids. Actas Dermosifiliogr. 2014;105:e55-60 pubmed publisher
    ..Treatment is usually symptomatic. We describe 7 cases in which oral corticosteroids-whose use continues to be controversial -were administered as a last resort for the control of pruritus. ..
  20. Okłota M, Niemcunowicz Janica A, Dziecioł J, Ptaszynska Sarosiek I, Klim B, Sackiewicz A, et al. [Morphological, microscopic changes in the thyroid gland in the cases of hanging in vertical position with open and closed noose]. Arch Med Sadowej Kryminol. 2011;61:331-6 pubmed
    ..The histopathological analysis showed that in one third of all the cases with negative macroscopic examination, it was discovered that microscopic changes indicated hanging alive...
  21. Oztoprak N, Celebi G, Temiz E. [An atypical measles case presenting with severe cervical spasm]. Mikrobiyol Bul. 2006;40:401-5 pubmed
    ..The aim of the presentation of this case was to emphasize that atypical measles should be considered for differential diagnosis in the cases complaining of muscle spasms and atypical skin rashes even if vaccinated against measles. ..
  22. Avilés Robles M, Gómez Ponce C, Resendiz Sánchez J, Rodríguez Tovar A, Ceballos Bocanegra A, Martínez Rivera Á. Disseminated penicilliosis due to Penicillium chrysogenum in a pediatric patient with Henoch-Schönlein syndrome. Int J Infect Dis. 2016;51:78-80 pubmed publisher
    ..disseminated infection caused by Penicillium chrysogenum in a 10-year-old boy with a history of Henoch-Schönlein purpura and proliferative glomerulonephritis, treated with immunosuppressors, is reported herein...
  23. Zhong J, Chen S, Xu L, Lai J, Liao Z, Zhang T, et al. Lower expression of PD-1 and PD-L1 in peripheral blood from patients with chronic ITP. Hematology. 2016;21:552-7 pubmed publisher
    T-cell dysregulation is a major event involved in immune thrombocytopenic purpura (ITP)...
  24. Chung D, Chen J, Ling M, Fu X, Blevins T, Parsons S, et al. High-density lipoprotein modulates thrombosis by preventing von Willebrand factor self-association and subsequent platelet adhesion. Blood. 2016;127:637-45 pubmed publisher
    ..Finally, a potential role for ApoA-I in microvascular occlusion associated with thrombotic thrombocytopenic purpura and sepsis was revealed by the inverse relationship between the concentration of ApoA-I and that of hyperadhesive ..
  25. Tao Y, Fang F, Hu S, Lu J, Cao L, Zhao W, et al. Hypermethylation of the GATA binding protein 4 (GATA4) promoter in Chinese pediatric acute myeloid leukemia. BMC Cancer. 2015;15:756 pubmed publisher
    ..06 ± 70.94; P = 0.011) compared to normal bone marrow/idiopathic thrombocytopenic purpura controls (116.76 ± 105.39)...
  26. Jelic Puskaric B, Rajković Molek K, Raic L, Batinic D, Konja J, Kardum Skelin I. Rhabdomyosarcoma with bone marrow infiltration mimicking hematologic neoplasia. Coll Antropol. 2010;34:635-9 pubmed
    ..Adjuvant technologies (cytochemistry, immunocytochemistry, cytogenetic analysis, flow cytometry, and molecular analysis) can be very helpful in diagnostic work-up, and may lead to definitive diagnosis in some cases. ..
  27. Lu S, Liu D, Xiao J, Cheng G, Zhang X, Liu Z, et al. Correlation Between Clinicaland Pathological Characteristics of Henoch-Schönlein Purpura Nephritis in Adults. Iran J Kidney Dis. 2016;11:12-17 pubmed
    Henoch-Schönlein purpura nephritis (HSPN) mainly affects children and is less common in adults, but its associated pathological changes are severe in adults, in whom it results in a poor prognosis...
  28. Aysan E, Bektas H, Ersoz F, Sari S, Huq G. Effects of contractubex on the prevention of postoperative peritoneal adhesion. J Surg Res. 2010;164:193-7 pubmed publisher
    ..045 and P = 0.038, respectively) but did not significantly differ from those in group 2 (P = 0.171 and P = 0.124, respectively). A single dose of contractubex did not prevent PPA formation but did diminish the amount of formed PPAs. ..
  29. Rurali E, Banterla F, Donadelli R, Bresin E, Galbusera M, Gastoldi S, et al. ADAMTS13 Secretion and Residual Activity among Patients with Congenital Thrombotic Thrombocytopenic Purpura with and without Renal Impairment. Clin J Am Soc Nephrol. 2015;10:2002-12 pubmed publisher
    Acute renal impairment is observed in 11%-23% of patients with congenital thrombotic thrombocytopenic purpura (TTP) and deficiency of a disintegrin and metalloprotease with thrombospondin motifs 13 (ADAMTS13, a metalloprotease that ..
  30. Hendrickson J, Hillyer C. Noninfectious serious hazards of transfusion. Anesth Analg. 2009;108:759-69 pubmed publisher
    ..transfusion-related acute lung injury, transfusion-associated circulatory overload, posttransfusion purpura, transfusion-associated graft versus host disease, microchimerism, transfusion-related immunomodulation, ..
  31. Sinha R, Kanabar D. Medical image. Meningococcal septic shock with adrenal apoplexy--Waterhouse-Friderichsen syndrome. N Z Med J. 2006;119:U2096 pubmed
  32. Sahebekhtiari N, Thomsen M, Sloth J, Stenbroen V, Zeviani M, Gregersen N, et al. Quantitative proteomics suggests metabolic reprogramming during ETHE1 deficiency. Proteomics. 2016;16:1166-76 pubmed publisher
    ..All MS data have been deposited in the ProteomeXchange with the dataset identifiers PXD002741 (http://proteomecentral.proteomexchange.org/dataset/PXD002741) and PXD002742 (http://proteomecentral.proteomexchange.org/dataset/PXD002741). ..
  33. Zuo B, Zhai J, You L, Zhao Y, Yang J, Weng Z, et al. Plasma microRNAs characterising patients with immune thrombocytopenic purpura. Thromb Haemost. 2017;117:1420-1431 pubmed publisher
    Altered microRNA (miRNA) expression has been reported in patients with immune thrombocytopenic purpura (ITP). However, the detailed expression profiling of cell-free circulating miRNAs in ITP patients has not been fully investigated...
  34. Neri I, Savoia F, Guareschi E, Medri M, Patrizi A. Purpura after application of EMLA cream in two children. Pediatr Dermatol. 2005;22:566-8 pubmed
    ..blanching, erythema, urticaria, allergic contact dermatitis, irritant contact dermatitis, hyperpigmentation, and purpura. We report two children with a purpuric reaction after application of this mixture cream...
  35. Tanghetti E, Sherr E, Sierra R, Mirkov M. The effects of pulse dye laser double-pass treatment intervals on depth of vessel coagulation. Lasers Surg Med. 2006;38:16-21 pubmed
    ..Histology revealed increased vascular coagulation depth at purpura threshold for intervals of 1, 10, 30, and 60 seconds between passes compared to single pass treatment, and a ..
  36. Kistler A. [Atypical hemolytic uremic syndrome (aHUS): new insights into pathogenesis leading to novel therapeutic approaches]. Praxis (Bern 1994). 2016;105:389-96 pubmed publisher
    ..diseases has traditionally been divided on clinical grounds by affected organs into thrombotic-thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS), the latter being termed atypical if not preceeded by diarrhea...
  37. Varela J, Penide L, Abad A, Benito J, Navia J. [Pneumomediastinum and extensive subcutaneous emphysema after normal labor]. Rev Esp Anestesiol Reanim. 2008;55:637-9 pubmed
    ..This peripartum complication is usually self-limiting when the aggravating factors are no louguer present. Management includes strict monitoring of the patient and conservative treatment of symptoms. ..
  38. Eder L, Bitterman H. Image in clinical medicine. Amyloid purpura. N Engl J Med. 2007;356:2406 pubmed
  39. Queliza K, Ihekweazu F, Ali A, Kellermayer R. Inflammatory Bowel Disease and Immune Thrombocytopenic Purpura: Combined Immune Dysregulation in an Adolescent. Ann Clin Lab Sci. 2017;47:226-228 pubmed
    Concomitant inflammatory bowel disease (IBD) and immune thrombocytopenic purpura (ITP) is a rare phenomenon. A shared immunologic pathway leading to mucosal inflammation and platelet destruction has been proposed...
  40. Kasahara K, Gotoh Y, Kuroyanagi Y, Nagano C. Warfarin-induced toxic epidermal necrolysis in combination therapy of Henoch-Schönlein purpura nephritis: a case report. BMC Nephrol. 2017;18:237 pubmed publisher
    ..We present the case of a 3-year-old patient who developed TEN while receiving treatment for Henoch-Schönlein purpura nephritis (HSPN)...
  41. López Mejías R, Genre F, Remuzgo Martínez S, Sevilla Pérez B, Castañeda S, Llorca J, et al. Interleukin 1 beta (IL1ß) rs16944 genetic variant as a genetic marker of severe renal manifestations and renal sequelae in Henoch-Schönlein purpura. Clin Exp Rheumatol. 2016;34:S84-8 pubmed
    ..be associated with severe renal involvement and persistent renal damage (renal sequelae) in Henoch-Schönlein purpura (HSP)...
  42. Alqanatish J, Alqahtani F, Alsewairi W, Al kenaizan S. Childhood scurvy: an unusual cause of refusal to walk in a child. Pediatr Rheumatol Online J. 2015;13:23 pubmed publisher
    ..Skin examination revealed extensive ecchymoses, hyperkeratosis and follicular purpura with corkscrew hairs, in addition to gingival swelling with bleeding...
  43. Byard R. The brassiere 'sign' - a distinctive marker in crush asphyxia. J Clin Forensic Med. 2005;12:316-9 pubmed
    ..This brassiere 'sign' provided a readily observable and easily recordable sign of crush asphyxia due to chest compression, and illustrated that vascular engorgement is necessary for the development of petechiae in these circumstances. ..
  44. Rousset L, Cordoliani F, Battistella M, Jachiet M, Pillebout E, Rybojad M, et al. Vasculitis and IgA monoclonal gammopathy of cutaneous significance. J Eur Acad Dermatol Venereol. 2017;: pubmed publisher
    IgA vasculitis (Henoch-Schonlein purpura) is a small vessel systemic vasculitis involving IgA immunoglobulin polyclonal activation1 ...
  45. Raslan H, Ezzat W, Abd El Hamid M, Emam H, Amre K. Skin manifestations of chronic hepatitis C virus infection in Cairo, Egypt. East Mediterr Health J. 2009;15:692-700 pubmed
    ..0, 2.7 and 1.8 respectively), and shrunken liver was significantly associated with pruritus (relative risk 2.1). Sex was not associated with any of the skin lesions...
  46. Nishio H, Tsukamoto T, Matsubara T, Okada Y, Takahashi R, Yanagita M. Thrombotic microangiopathy caused by interferon ?-1b for multiple sclerosis: a case report. CEN Case Rep. 2016;5:179-183 pubmed publisher
    ..mild decrease in ADAMTS13 activity and absence of ADAMTS 13 inhibitor could not cause thrombotic thrombocytopenic purpura, plasma exchange was stopped...
  47. Zipursky J, Alhashemi A, Juurlink D. A rare presentation of an ancient disease: scurvy presenting as orthostatic hypotension. BMJ Case Rep. 2014;2014: pubmed publisher
    ..We believe that this case describes a rare presentation of scurvy and highlights a previously under-reported connection between scurvy and vasomotor instability. ..
  48. Suárez Peñaranda J, Alvarez T, Miguéns X, Rodríguez Calvo M, de Abajo B, Cortesão M, et al. Characterization of lesions in hanging deaths. J Forensic Sci. 2008;53:720-3 pubmed publisher
    ..1%), the jugular vein (2.2%), and ruptures of the carotid adventitial layer (21.7%). These could be partially associated with the use of a hard fixed noose and body weight...
  49. Schott F, Gross A, Netsch C, Segerer S. [Thrombotic thrombocytopenic purpura after circumcision]. Urologe A. 2017;56:361-363 pubmed publisher
    ..hemolytic anemia and thrombocytopenia, which led to the diagnosis of postoperative thrombotic thrombocytopenic purpura (TTP)...
  50. Thomas R, Thal S. [Case report: 40-year-old patient with massive bleeding undergoing cesarean section]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2016;51:316-20 pubmed publisher
    ..After an abdominal compartment syndrome and an ARDS a post transfusion purpura was found to be the cause of the repeated bleeding and could successfully be treated with a cycle of ..
  51. Xu H, Jiang G, Shen H, Li W, Mao J, Pan Y. Association of TLR4 gene polymorphisms with childhood Henoch-Schönlein purpura in a Chinese population. Rheumatol Int. 2017;37:1909-1915 pubmed publisher
    ..that aberrant activation of Toll-like receptor (TLR) 4 was involved in the pathogenesis of Henoch-Schönlein purpura (HSP)...
  52. João C, Negi V, Kazatchkine M, Bayry J, Kaveri S. Passive Serum Therapy to Immunomodulation by IVIG: A Fascinating Journey of Antibodies. J Immunol. 2018;200:1957-1963 pubmed publisher
    ..c. forms. Following successful use of IVIG in immune thrombocytopenic purpura, there has been an explosion in the therapeutic applications of IVIG in diverse autoimmune and inflammatory ..
  53. Stotler B, Schwartz J. How we use WinRho in patients with idiopathic thrombocytopenic purpura. Transfusion. 2015;55:2547-50 pubmed publisher
    ..This report details the transfusion medicine consultation practice and guidelines at a tertiary care academic medical center for the usage of WinRho SDF in patients with ITP. ..