Actinic Purpura - A Dermal Disorder

Introduction:

Actinic purpura is a dermal disorder affecting the connective tissues. Actinic purpura occurs due to chronic or prolonged sun exposure. Bateman first described actinic purpura in 1818. Actinic purpura was also known as Bateman senile purpura or Bateman disease. It is observed that actinic purpura usually affects adult people. Dark purple-colored patches in the sun-exposed areas characterize the signs of actinic purpura. The most commonly involved areas of actinic purpura are the hands and the upper extremities. The symptoms of actinic purpura are usually resolved in three weeks.

What Is Actinic Purpura?

Actinic purpura is also known as solar purpura, Bateman purpura, Bateman disease, Bateman senile purpura and senile purpura. Actinic purpura arises due to chronic exposure and causes abnormalities in the dermal connective tissues. Actinic purpura has no gender predilection.

Sun-exposed areas include:

• The external surface of the forearm.

• The back region of the hands.

• The neck region.

• The face.

• Exposed areas of the legs.

What Are the Causes of Actinic Purpura?

Long-term exposure or prolonged exposure to the sun causes actinic purpura. Actinic or solar purpura occurs due to the sun's or ultraviolet or UV rays' effects on the skin, causing ultraviolet dermal atrophy. People with fair skin and adults are more susceptible to actinic purpura. Extravasation of blood into the dermis layer causes the actinic purpura. Chronic sun exposure causes skin atrophy, and the minor blood vessels become fragile, causing bleeding into the dermis layer of the skin. In addition, the skin is sensitive to minor trauma and other similar forces causing bleeding. Skin atrophy may also occur due to aging and a history of prolonged sun exposure.

The most common causes of actinic purpura are given below.

• Chronic sun exposure.

• Ultraviolet rays or UV rays exposure.

• Skin atrophy (thin skin).

• Photo aging (premature skin aging due to sun exposure).

• Dermatoporosis (skin fragility).

• Minor trauma or other shearing forces.

• Fragile blood vessels.

What Are the Signs and Symptoms of Actinic Purpura?

The signs of actinic purpura are the dark purple-colored patches and macules. The edges of the patches are irregular, and the commonly involved areas are the forearm, hands, face, neck, and legs. The lesions of actinic purpura are usually present with dark purple macules. Extensive ecchymosis is present in actinic purpura conditions, and the lesion size ranges from 0.39 to 1.57 inches in diameter.

Symptoms like pruritus (itching) and tenderness are absent in actinic purpura. Sometimes, the macules of actinic purpura are asymptomatic. The surrounding skin is inelastic and thin-pigmented. Other symptoms like wrinkling, pseudo stellate scars (irregular star-shaped atrophic scars), lentigines (freckle-like spots), actinic keratosis (scaly spots and patches), and the skin appearing with a sallow yellow hue are seen. Symptoms of actinic purpura last for three weeks, and they resolve spontaneously after three weeks. Ecchymosis (blood pooling under the skin) affects the body's beauty. Actinic purpura has no severe complications.

What Is the Diagnosis of Actinic Purpura?

The diagnosis of actinic purpura is mainly based on clinical and histological findings. Clinical examination involves proper history and physical inspection of the patient. Hemosiderin deposits are indicated with Perl's stain. The coagulation analysis is required in rare cases, and the results show no abnormalities.

• A proper history of the patient, which includes sun exposure.

• Symptoms like dark purple patches with irregular patches are examined during the physical examination.

• The biopsy is done.

Histopathological findings of actinic purpura will show the following features.

• Thin epidermis.

• The dermis is altered.

• Collagen fibers are reduced.

• Elastic fibers are abnormal.

• Extravasation of blood cells.

• Rarely neutrophilic infiltration.

• No inflammatory changes.

• No abnormalities in the coagulation analysis.

• Perl's stains mark the hemosiderin pigments.

What Is the Treatment for Actinic Purpura?

The symptoms of actinic purpura are spontaneously resolved within three weeks. Actinic purpura does not require any specific treatment. Preventing or limiting sun exposure and ultraviolet rays will reduce or avoid the incidence of actinic purpura. Actinic purpura is a benign condition. Preventing skin from chronic sun exposure and ultraviolet rays can be done with sunscreen containing a sun protection factor (SPF) greater than 50.

Wearing clothes with long sleeves and pants will also reduce the chances of acquiring actinic purpura. The skin should be protected from ultraviolet rays A or UVA, and ultraviolet B or UVB should be done by applying sunscreen in sun-exposed areas. A derivative of vitamin A called tretinoin, or retinoic acid, will reverse skin damage due to sun or other artificial sources. The topical application of tretinoin improves collagen and elastic fiber production. Photo aging effects can be resolved with laser therapy. Skin dryness is treated with skin moisturizers.

What Is the Differential Diagnosis of Actinic Purpura?

The symptoms of actinic purpura are similar to those of other dermal conditions. However, the distinguishing features will help establish a differential diagnosis and avoid misdiagnosis.

The differential diagnosis of actinic purpura is mentioned below.

• Purpura, steroid induced purpura.

• Physical trauma.

• Side effects of anticoagulants.

• Vitamin C deficiency or scurvy.

• Palpable purpura, with bleeding and inflammation.

• Amyloidosis (a condition in which abnormal build-up of protein within the internal organs), primary systemic amyloidosis in particular.

• Psychogenic purpura (due to stress, the person develops painful bruises on the face and extremities).

What Is the Outlook for Actinic Purpura?

Actinic purpura is a common condition in which red bruises appear on the skin, such as on the forearms and hands. These occur due to fragile blood vessels under the skin that rupture easily. This occurs due to chronic sun exposure or aging. The condition is non-cancerous and does not cause serious health complications. The outlook of the disease is generally positive. Preventive care can reduce the frequency of bruises and protect the skin from further damage.

What Are the Preventive Measures for Actinic Purpura?

The preventive measures for actinic purpura are as follows:

• Apply a broad-spectrum sunscreen.

• Wear long-sleeved protective clothing.

• Avoid direct sun exposure.

• Avoid tanning.

• Apply moisturizer to the skin to maintain skin elasticity.

• Avoid rough scrubbing.

• Take a balanced diet.

• Drink plenty of water.

Conclusion

Actinic or solar purpura is a benign dermal connective tissue disorder due to chronic sun exposure or other ultraviolet or UV rays. Actinic purpura is characterized by dark purple patches and macules on the sun-exposed areas such as hands, face, forearm, neck, and legs, affecting older people. Symptoms are usually resolved within three weeks. Actinic purpura does not require any specific treatment. Derivatives of vitamin A or retinoids will reverse the skin damage and promote collagen and elastic fiber production. Photoaging effects can be improved with laser therapy. However, the prognosis of actinic purpura is excellent. Limiting or avoiding sun exposure will reduce or prevent the incidence of actinic purpura.