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. The signs of actinic purpura are characterized by dark purple-colored patches in the sun-exposed areas. 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.

Sun-exposed areas include:

• The external surface of the forearm.

• The back region of the hands.

• The neck region.

• The face.

Actinic purpura has no gender predilection.

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 as a result of 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.

• Photo aging.

• Dermatoporosis.

• Minor trauma or other shearing forces.

• Fragile blood vessels.

What Are the Signs 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 1 to 4 cm in diameter.

Symptoms like pruritus 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, lentigines, actinic keratosis, 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 affects the cosmesis. Actinic purpura has no severe complications.

The signs of actinic purpura are mentioned below.

• Dark purple patches and macules.

• Extensive ecchymosis.

• Lesion is 1 cm- 4 cm in diameter.

• Pruritus is absent.

• Tenderness is absent.

• Pigmented and inelastic surrounding skin.

• Photoaging symptoms lie in wrinkling, lentigines, and actinic keratosis present.

• Sallow yellow-hued skin.

What Is the Diagnosis of Actinic Purpura?

Diagnosis of actinic purpura is mainly the clinical and histological findings. Clinic examination involves the 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. Prevention or limiting sun exposure, ultraviolet rays, or UV rays will reduce or avoid the incidence of actinic purpura. Actinic purpura is a benign condition. Prevention of skin from chronic sun exposure or ultraviolet rays, UV rays can be done with sun protection factor or SPF which is greater than 50, containing sunscreen.

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.

The various treatment measures for treating actinic purpura are given below.

• Reducing or avoiding chronic sun exposure.

• Avoid ultraviolet rays or UV rays exposure.

• Sunscreen containing a sun protection factor of more than 50 is applied to sun-exposed areas.

• Long sleeve pants and clothing can be done.

• Vitamin A or retinoids promotes collagen and elastic fiber production.

• Topical application of tretinoin.

• Laser therapy to treat photoaging effects.

• Skin moisturizers to treat skin xerosis.

What Is the Differential Diagnosis of Actinic Purpura?

The symptoms of actinic purpura are similar to other dermal conditions. However, the distinguishing features will lead to differential diagnosis and help 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, primary systemic amyloidosis in particular.

• Psychogenic purpura.

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.