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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA

A Journal on Dermatology and Sexually Transmitted Diseases


Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 1999 December;134(6):553-6

language: Italian

Morphologic stages of senile purpura

Piccolo D. 1, Soyer H. P. 2, Schaeppi H. 3, Chimenti S. 1

1 Università degli Studi - L’Aquila, Clinica Dermatologica;
2 Università degli Studi - Graz (Austria), Clinica Dermatologica;
3 Ospedale Civile - Salisburgo (Austria), Clinica Dermatologica


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Senile purpura is a well known, common dermatosis of elderly patients occurring on severely sun-damaged skin, especially on the extensor surfaces of the forearms. Clinical differential diagnoses include fixed drug reaction, phototoxic drug reaction, porphyria cutanea tarda and hemorrhagic contact dermatitis. Recently 6 patients with senile purpura (4 females and 2 males; age range 69 to 79 years) submitted to biopsy for difficult clinical diagnoses have been observed. Based on the histopathologic examination three morphologic stages of senile purpura, namely, early, fully developed and late (fibrotic) stage were identified. The early stage was characterized by a dense diffuse infiltrate of extravasate erythrocytes and only a sparse infiltrate of lymphocytes within severe solar elastosis. The fully developed stage consisted of a slightly to moderately dense accumulation of extravasate erythrocytes. In addition, there was a sparse infiltrate of lymphocytes and mast cells as well as numerous fibrocytes in interstitial distribution. Within the elastosis material in the upper dermis several irregularly shaped, pseudocystic spaces and clefts reminiscent of bullous solar elastosis were observed. Subsequently, only few or no extravasate erythrocytes were present. However, beside a sparse infiltrate of lymphocytes there was an increased number of diffusely distributed siderophages in the dermis. The late stage of senile purpura is characterized clinically by the appearance of the so-called stellate pseudo-cicatrices and histopathologically, presumably, by an increase of fibrosis. The histopathologic spectrum of senile purpura ranges from a dense diffuse infiltrate of extravasate erythrocytes in early stage, irregulary shaped cystic spaces within a marked solar elastosis in fully developed stage to absence of extravasate erythrocytes and increased fibrosis in late stage. Bullous solar elastosis probably represent nothing but a variant on the theme of the fully developed stage of senile purpura.

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