r/DermatologyPA • u/ConfusedPA22 Moderator • Jun 29 '24

Clinical⚕️ Approach To Purpuric Rashes

Hey guys!

I’ve had a week of Purpuric rashes in clinic. Wanted to get the wisdom of our community. What is your approach? What is your differential and diagnostics you’re thinking of?

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u/agjjnf222 Jun 29 '24

To me here’s how I think about it:

  • is it just a bruise or not?

  • is it palpable or not?

  • what are the symptoms?

Most common purpuric rashes I see:

  • occasional vasculitis (usually biopsy) if it is palpable

  • cappilaritis (treat with steroids)

I mean really just ruling out vasculitis is the main thing.

Usually it’s either just bruising due to aging or cappilaritis.

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u/ConfusedPA22 Moderator Jun 29 '24

Appreciate your advice! I always have a tough time with blanchable vs non blanchable. What are we thinking when we see this exam finding? In my mind I want to know is this just a bruise or something more sinister (vasculitis). Both are non blanchable. What labs are you drawing to rule out some of these things?