DermDx: Bruising on Arms in Older Patient

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An 83-year-old man is referred for biopsy of a scalp lesion. His past medical history includes treatment for skin cancers and actinic keratoses. As a farmer, he admits to ample past sun exposure and never uses sunscreen. He denies a history of internal malignancy or new-onset fatigue, swollen glands, bleeding gums, or recent tick bite. He is currently on antihypertensives and a “blood thinner.” An incidental finding is noted of multiple bruised areas on both arms which “last a bit” and then go away. The bruises are not physically bothersome but necessitate his wearing long sleeve shirts in public.

Actinic purpura is also referred to as senile purpura or Bateman disease after the physician who first described this condition in 1818.1 The disorder occurs in older persons with a history of chronic sun exposure. The dorsal surface of the...

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Actinic purpura is also referred to as senile purpura or Bateman disease after the physician who first described this condition in 1818.1 The disorder occurs in older persons with a history of chronic sun exposure. The dorsal surface of the hands and extensor surfaces of the arms are the most commonly involved sites. Both sexes are affected equally and the prevalence increases with advanced age with up to 30% of individuals over 75 years of age experiencing this purpuric event.  

Actinic purpura is considered a manifestation of dermatoporosis, which is a descriptive term referring to chronic cutaneous fragility syndrome.2 In one study, cases of senile purpura were unrelated to chronic sun exposure but positively correlated with anticoagulant therapy.3 Our patient had both risk factors. Regardless of the cause, this commonly encountered purpuric condition results from capillary fragility and extravasation of red cells into the dermis. Patients should be reassured that, although unsightly, individual lesions will resolve within 2 to 3 weeks. Resolution may be hastened by use of an IPL (intense pulsed light) device.4

Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Hafsi W, Masood S, Badri T. Actinic purpura. In: StatPearls [Internet]. StatPearls Publishing; August 1, 2022. PMID: 28846319.

2. Wollina U, Lotti T, Vojvotic A, Nowak A. Dermatoporosis – the chronic cutaneous fragility syndrome. Open Access Maced J Med Sci. 2019;7(18):3046-3049. doi:10.3889/oamjms.2019.766

3. Cho SI, Kim JW, Yeo G, et al. Senile purpura: clinical features and related factors. Ann Dermatol. 2019;31(4):472-475. doi:10.5021/ad.2019.31.4.472

4. Siperstein R, Wikramanayake TC. Intense pulsed light as a treatment for senile purpura: a pilot study. Lasers Surg Med. 2021;53(7):926-934. doi:10.1002/lsm.23358

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