Contents
What is purple?
Purpura is a symptom in which the individual is affected by spots and plaques of different sizes and a purple color on the skin or mucous membranes.
There are several types of purple. It can be divided into thrombocytopenic – when there is a reduction in platelets, structures also called thrombocytes and which are responsible for blood clotting – and non-thrombocytopenic, when there is no decrease in platelets.
To build a clot (the body’s natural process), many platelets are used. When the individual has thrombocytopenia , the amount of platelets is abnormally reduced in the bloodstream. As a consequence, spontaneous bleeding, bruising and changes in the woman’s menstrual cycle may appear.
The blemishes can occur due to the rupture of blood vessels, generating an accumulation of blood under the skin.
This rupture can be caused by a breakdown of blood capillaries (tiny vessels in the circulatory system), changes in blood clotting (due to low platelets) or by certain medications.
When the stains are small and in great quantity, they are called petechiae (from 4 to 10 millimeters), in larger sizes, they are called ecchymoses (above 1 centimeter).
Depending on the duration of the problem, purpura can be categorized as recent, persistent (from 3 to 12 months) or chronic (equal to or greater than 12 months). In children, on the other hand, the symptom gradually disappears on its own.
The person with purple, in addition to the body markings, may suffer from bleeding and pain in the affected places.
Purpura can be found in the International Classification of Diseases (ICD-10) using the codes D65 (fulminant), D69.0 (rheumatoid), D69.2 (other non-thrombocytopenic purpura), D69.3 (immune thrombocytopenic) and M31.1 (thrombotic thrombocytopenic).
Platelets: what is their function?
Platelets are cytoplasmic portions without a nucleus, contained in the blood. They are produced by the bone marrow, with blood clotting being its main function.
In a wound, the blood gradually stops. This is because platelets group together and form clots or thrombi, which is why these structures are also known as thrombocytes .
They also drive vasoconstriction, a process in which blood vessels contract, shortening their diameter.
In the human body, platelets add up to about 140 thousand to 440 thousand per microliter (unit of measurement that corresponds to the millionth part of a liter).
In autoimmune conditions, for example, the organism does not recognize the platelets and destroys them, causing the purple spots. When its quantity is less than 50 thousand, bleeding can occur even in light bruises.
The most serious bleeding situations occur when platelets total 10,000 to 20,000 per microliter.
Types
Purpura can be classified as thrombocytopenic or non-thrombocytopenic.
Thrombocytopenic purpura
Thrombocytopenic purpura is defined by a reduction in the amount of platelets. Are they:
Idiopathic thrombocytopenic purpura (ITP)
Also called immune thrombocytopenic purpura, it affects between 1 in every 62,500 and 1 in every 25,600 adults a year. This type affects more women of childbearing age than men. In children, PTI occurs acutely and for a limited and determined period.
The disorder occurs by the decrease in platelets caused by an autoimmune condition, that is, the immune system itself eliminates platelets from the body. It is not known why this occurs, but in children the condition may be the result of a viral infection.
The most common symptoms include bleeding from the skin or mucous membranes, presented as petechiae or ecchymosis. Swelling, pain in the legs and menstrual bleeding are also indicative, which are more difficult to contain.
The intensity of the symptoms depends on each patient. For some, they do not even manifest themselves and do not need treatment.
Thrombocytopenic thrombocytopenia (PTT)
Common in adults, it is estimated that between 1 and 5 in every 10,000 individuals have PTT, an autosomal recessive disease (when a copy of the failed chromosomal gene is inherited from each parent) or multigenic / multifactorial (covers several genes).
Small body blood clots are formed unexpectedly. Obstruction of blood vessels occurs, the most affected being those of the brain, heart and kidneys.
As a result, red blood cells are compromised as they pass through partially closed blood vessels. The organs can also be damaged.
Possible causes include certain medications (such as quinine, cyclosporine and mitomycin C), pregnancy and autoimmune disorders.
The scarcity of platelets due to clotting can lead to complications, including leading to death. In the brain, it can cause headache , mental confusion, seizures and coma.
In other locations, coagulation causes changes in heart rate, blood when urinating and abdominal pain.
What is the difference between PTT and hemolytic-uremic syndrome?
Like PTT, hemolytic-uremic syndrome (HUS) also causes blood clots in body locations. However, HUS is more common in children. The initial signs include vomiting and diarrhea (followed by blood or not).
In this case, white blood cells are damaged when they pass through blocked blood vessels. There may also be damage to the renal canal, which directly affects blood urea levels, leading to renal failure.
Non-thrombocytopenic purpura
Non-thrombocytopenic purpura are those in which there is no reduction in the levels of platelets in the body.
Henoch-Schönlein purpura
Rheumatoid or Schönlein-Henoch (PHS) purpura, as it is also known, develops more in children (between 3 and 15 years old) than in adults.
It is estimated that for children the risk of having PHS is between 1 in 6,660 and 1 in 4,880, while in adults the probability is 1 in 1 million annually.
Inflammation is more recurrent in the skin, but it can affect the intestinal and renal blood vessels.
Its cause is unknown, but it may be related to the loss of function of immunoglobulin A (IgA) in blood vessels, such as arterioles (regulate blood pressure and route blood to capillaries), capillaries (responsible for the transport of blood) and venules (do oxygen-poor blood from the capillaries to the veins).
Other factors, such as bacteria, drugs, food and insect bites, can be identified as precursors to the disease.
The patches disappear on their own gradually after 4 weeks, but can return at least once. In 80% of cases, they don’t even appear again.
Purple can appear on the legs and buttocks. In adults, the condition is worsened, as the lesions are made up of necrotic or hemorrhagic blisters.
Withering purple
It particularly affects newborns as a result of insufficient clotting proteins . The spots may become black due to cell necrosis at the site.
Simple purple
Simple purple can be defined by the high number of bruises, which in turn, cause vascular fragility. This type appears on the thighs, buttocks or upper arms.
Despite a common condition, its origin is unknown. However, it can be related both to a group of disorders and to some modification in a normal mechanism.
Being a woman, having family cases, having low body mass, using corticosteroids in advance and high exposure to sunlight can increase the chances of having the problem.
However, it is not possible to prevent purple. Discontinuation of aspirin may be recommended, but there is no indication that the condition appears or has its condition aggravated due to the use of the medicine.
When the diagnosis is made, the results of the examinations of the number of platelets and their function, blood coagulation and fibrin are configured as normal.
Because it is a mild and uncomplicated condition, simple purple does not need treatment.
Senile purple
Recurrent in the elderly, senile purple creates ecchymosis, formed from the degeneration of the skin and blood vessels. The body regions most affected are hands and forearms.
The lesions disappear for a few days and may change their color to brown. Discoloration may become clearer over weeks, months or be permanent. There is no risk of the severity of this condition.
Causes
Purpura may be related to the rupture of capillaries (a phenomenon known as “capillary fragility”), problems with blood clotting or the use of some types of medication.
Capillary fragility
The rupture of capillaries is perceived in simple purple, caused by lesions on the skin or mucous membranes.
In specific situations, the circumstances that led to the appearance of purple are unknown. However, in general, capillary weakening is caused by allergic, hormonal, behavioral conditions, heredity, aging and lack of vitamin C in the body.
Allergies
Allergic people have an intolerance to certain substances considered normal for others. The components that trigger the body’s defense reactions are called allergens , generating sensitivity that is often excessive.
The person may suffer from inflammation, irritation and swelling of the skin, which can culminate in the rupture of blood vessels and cause bleeding.
The most common types of allergy originate from dust mites (microorganisms present in mattresses, pillows, blankets and carpets), pollen, animal hair, insects, food and medicines.
Hormonal
Hormonal changes resulting from menstruation, pregnancy or menopause affect blood vessel structures, restricting blood circulation.
Behavioral
Stress , anxiety and sadness can cause purple skin spots for unidentified reasons.
Heredity
Having cases of purpura in the family increases the chances of developing the disorder.
Aging
Due to aging, the structures that make up and maintain blood vessels become weaker, increasing the chances of senile purple.
Vitamin C deficiency
Vitamin C is intended to strengthen blood vessels and ensure that dilation occurs properly. Its lack in the organism can cause spontaneous rupture of the vessels, since they are weakened.
Changes in blood clotting
Certain diseases and health conditions are responsible for causing changes in blood clotting, directly affecting platelet levels or function. That is, the problem may be in the quality or quantity of these structures. The decrease in platelets leads to thrombocytopenia.
Among the related conditions are:
Viral and bacterial infections
Viral infections, such as dengue and HIV , in addition to bacterial infections, can cause a deficit in the number of platelets.
Dengue
Transmitted by the bite of the Aedes aegypti mosquito , dengue causes inflammation, a reduction in the amount of platelets and impairs the regulation of fluids in the body. The functioning of the liver and kidneys can also be impaired.
Despite presenting the same initial signs as the classic one, hemorrhagic dengue differs by the dilation of blood vessels.
As a result, the infected person is afflicted with bleeding gums, mouth, nose, ears or intestines, in addition to low blood pressure, which can lead to dizziness , falling, shock or in unusual cases, even death.
HIV
The human immunodeficiency virus (HIV) is a retrovirus, part of the subgroup of Lentiviridae . It attacks the immune system, particularly white blood cells.
The invading agent multiplies through changes in the cell’s DNA. Subsequently, the white blood cells are destroyed.
Due to the decline in the efficiency of defense mechanisms, the individual may be subject to other diseases.
Its transmission occurs sexually, through contact with blood and from mother to child. However, it is worth stressing that having the HIV virus does not mean that you have AIDS . Many people who live with the problem do not have the symptoms or develop the disease for years.
Autoimmune diseases
Some autoimmune diseases , such as lupus , vasculitis, hemolytic-uremic syndrome (HUS) and hypothyroidism cause the destruction of platelets.
Lupus
Known only as lupus, the systemic lupus erythematosus disease is caused by the individual’s own immune system which generates antibodies in excess.
The body is hit by excess antibodies, causing inflammation of the skin, joints, eyes, kidneys, brain, heart and lungs.
The appearance of symptoms is variable for each person, who can live with the disorder for years without feeling anything.
Among the symptoms are reddish spots on the body, mainly on the face, neck, chest and elbows; joint, head and breathing pain; and, in more aggravated conditions, seizures.
Vasculites
Vasculitis is the name given to the inflammation of blood vessels, promoted by diseases that cause the cells of the immune system to invade the walls of the vessels. This condition causes suppression of the blood flow space, and can even close it completely.
There may be aneurysm (abnormal dilation of blood vessels, especially an artery) and hemorrhage. Because of the need for blood circulation for the performance of the organs, all the body’s mechanisms can suffer symptoms and trauma.
The signs include tiredness , malaise, loss of muscle mass, joint and abdominal pain, fever , not feeling like eating.
Hypothyroidism
When the body’s means of defense attack the thyroid gland – in charge of making hormones such as triiodothyronine (T3), thyroxine (T4) and calcitonin, which are essential to balance the metabolism – there is low or no production of thyroid hormone.
The person may experience pain in the muscles and joints, swelling in the face, excessive or irregular menstrual flow, constipation, dry hair, among other symptoms.
Liver diseases
The liver, in conjunction with vitamin K , makes a protein called prothrombin, which aids in blood clotting.
Liver disease and a lack of vitamin K in the body can alter the production of prothrombin. This favors the appearance of bleeding, originating from bruises or spontaneously through the nose, gums, urine.
Bone marrow diseases
Bone marrow (or marrow) is a liquid-gelatinous tissue present inside the bones, responsible for forming red blood cells (red blood cells), leukocytes (white blood cells) and platelets.
Pathologies such as aplastic anemia or myelodysplasia cause the reduction or incorrect manufacture of cells.
Aplastic anemia
Aplastic anemia is a very rare and autoimmune disease. The bone marrow stops producing new blood cells. The incidence of cases in Brazil per year is less than 15 thousand.
The most common indications are spontaneous purple spots, pallor on the skin and mucous membranes and hemorrhage for long periods, even in wounds seen as unimportant. Without treatment, the condition can be fatal within 10 months due to infections.
Mielodisplasia
Myelodysplasia, or myelodysplastic syndrome (SMS), is the term used to define several diseases that cause the suspension of blood cell production and, thus, bring a series of complications to the carrier.
Some people do not show signs of SMS. But when they have them, the most recurring ones are dizziness, weakness or tiredness, bruises, bleeding and infections.
This condition can progress to acute leukemia, a type of cancer that develops quickly and that reproduces still immature leukocytes, that is, incapable of exercising its functions in the defense of the organism, bone marrow and blood.
Genetic diseases
Genetic diseases, such as hemophilia (the blood does not clot properly), interfere with blood clotting.
Deficiency of vitamins and minerals
The lack of vitamins and minerals, such as iron, folic acid and vitamin B12, affects the production of red blood cells, platelets and white blood cells promoted by the bone marrow.
Medicines
Some medications, such as aspirin, anticoagulants and ibuprofen, can impair the blood clotting process as well as the performance of platelets.
Risk factors
There are not exactly risk factors for the appearance of purple. Some people are more likely to develop autoimmune diseases, especially if they have cases in the family.
Some conditions that can favor its appearance are:
- Changes in blood clotting due to medications or diseases;
- Infectious pathologies, mainly in children and the elderly;
- Poor diet that causes a lack of vitamin C;
- Cancers, such as leukemia and myeloma;
- Inflammatory problems;
- Advanced age;
- Deterioration of blood vessels.
Cases of idiopathic thrombocytopenic purpura (ITP), for example, are more recurrent in patients who already have autoimmune conditions or chronic lymphocytic leukemia.
Symptoms
The most evident symptoms of purpura are purplish-colored patches on the skin or mucous membranes , caused by lesions or that appeared spontaneously.
In women and children, spots on the legs and thighs can appear even in mild bruises or for no apparent reason.
Over time, the spots will become lighter, turning from purple to brown and then to yellow, until it disappears completely. In addition, red spots on the body, pain in the area of the spots and fever are other indications of the problem.
If the person has idiopathic thrombocytopenic purpura and the number of platelets is 50 thousand or more per milliliter, the symptoms tend not to appear for a certain period.
Below this value, the individual may also be affected by:
- Bleeding (in the gums, organs of the digestive system or in the urinary tract);
- Epistaxis (bleeding from the nose);
- Increased menstrual flow in women;
- Pain in the legs and joints;
- Hemorrhages;
- Longer blood clotting;
- In uncommon cases, edema (accumulation of fluid in the base tissue of the skin) and menstrual bleeding can occur;
- Sickness;
- Vomiting;
- Diarrhea;
- Stomachache;
- Protein or blood in the urine;
- Excessive tiredness.
In rare situations of idiopathic thrombocytopenic purpura, the patient is still at risk of presenting splenomegaly .
This disorder is characterized by an increase in the volume of the spleen, an organ whose function is the manufacture, storage, control and elimination of blood cells.
Purple spots on babies: what can it be?
Most of the time, the spots present since the baby’s birth, with a purplish aspect, are defined as Mongolian spots .
These, in turn, are associated with the child’s ancestors, being more frequent in those with Asian, indigenous, Hispanic or African descent.
Usually, the spots are on the bottom, but can also appear on the lower back, shoulders, back or other regions of the baby’s body, measuring around 2 to 8 centimeters.
The spots are not cancerous and disappear on their own until 2 years of age. In most cases, they are not indicative of disorders.
If the stain is found in other areas of the baby’s body, if it is not so large or appears unexpectedly, it may be indicative of strokes, capillary fragility or any other problem that alters blood clotting.
It is important to check if the marks are abundant, in excess sizes, accentuated throughout the day and followed by other symptoms, such as fever, bleeding or drowsiness. In these cases, the doctor should be consulted immediately.
How is the diagnosis made?
Depending on the signs presented, the medical consultation can be made with an angiologist , dermatologist or hematologist .
The clinical history is taken into account at the time of diagnosis. In addition, some tests are usually ordered to determine the cause of the problem. The most common include:
Blood test
Through blood collection procedures are performed, such as complete blood count and blood smear.
Blood count
The CBC is a blood test that counts blood components, in this case, platelets.
Based on the results, it is possible to predict the risk of bleeding:
- Equal or above 50 thousand per microliter: minimum;
- 20,000 to 50,000 per microliter: little bleeding after bruising;
- Below 20 thousand per microliter: spontaneous bleeding;
- Below 5,000 per microliter: severe spontaneous bleeding, probably at risk of death.
Blood smear
Through the blood smear, also called manual differential count or cell morphology, the appearance and levels of red blood cells, leukocytes and platelets are analyzed.
Bone marrow aspirate
Formally known as bone marrow aspirate or bone marrow biopsy and, popularly, as myelogram, this method consists of taking a sample of bone marrow tissue.
The aim is to ascertain the types, number and development of cells, in addition to assessing the interstitial structures (small space between one region and another) of the bone marrow.
It can also be used to rule out cancer risk, which can cause changes in platelet levels.
Differential diagnosis
As the symptoms of the disease are generally not specific, it is necessary to eliminate other possible causes, such as autoimmune diseases, viral infections and medications.
Does purple have a cure?
Depending on the type of purple, it can be cured. The simple purple and the blemishes resulting from strokes disappear spontaneously. In cases of ITP, for example, which is an autoimmune condition, there is no cure.
In children, the purple usually disappears on its own, without the need for treatment. In adults, it needs to be treated, and it can develop into a chronic and recurrent problem.
What is the treatment?
Treatment is only necessary when the number of platelets is below 30 thousand per microliter or in cases of bleeding.
The choice to be made will depend on the cause of the disease. You may be asked to stop medications that affect platelet production.
Among the options are:
Corticosteroids
Medicines based on corticosteroids (steroid hormones produced by the adrenal glands) help fight antibodies that destroy platelets. In this way, the amount of platelets increases.
The recovery period from this treatment is shorter for children, ranging from weeks to months. Adults, on the other hand, need more time. Only a few manage to rehabilitate themselves in the first year.
Prolonged use of these drugs can lead to several side effects, including increased body mass, irritability, insomnia , swelling and mood swings.
Adults who do not respond satisfactorily to the use of corticosteroids, may use other medications that mitigate the effects of the immune system.
Intravenous immunoglobulin
Like corticosteroids, immunoglobulin applied intravenously helps to reduce platelet destruction.
In cases of acute bleeding, it can be administered in high doses to contain the condition. It can also be used to quickly increase platelet counts before surgery.
However, its effect is brief. Side effects involve headache, feeling sick or vomiting.
Creams and ointments
Creams and ointments promote the reabsorption of blood that is outside the blood vessels.
Spleen removal surgery
Removal of the spleen through surgery can be indicated in severe conditions (thrombocytopenic purpura), when the patient has not responded to previous treatments.
The spleen produces antibodies that are able to damage platelets, thereby causing body stains.
The procedure is known as splenectomy , performed by videolaparoscopy. This method consists of 3 small holes through which tubes and equipment necessary to carry out the extraction pass through.
In this case, you need general anesthesia, which lasts about 3 hours. The patient is usually discharged in 2 days.
Because it is a non-invasive surgery with small cuts, the patient feels less pain and undergoes a shorter recovery time. However, in certain situations, there may be a need for open surgery, with a larger cut.
Platelet transfusion
Used as a last resort, platelet transfusion is recommended for those who are at immediate risk of death. This is because the new platelets can also be destroyed by the agent causing the disorder.
Medicines
The medications to be used vary according to the type of purple presented. Commonly prescribed are:
- Dexamethasone ( Acetazone , Bexeton , Decadron Tablet , Decadron Elixir , Decadron Injectable , Dexamethasone );
- Phosphate sodium of Prednisolona ( EMS-Pred , Prediped , Prednisolon , Predsim , Prelone Solução Oral , Prenisol , Prosolin , Oralpred , Redizol );
- Hydrocortisone Sodium Succinate ( Androcortil , Ariscorten , Solu Cortef ).
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Prognosis
The prognosis of purpura will depend on the reason for its appearance. After confirming the diagnosis, the specialist will point out the treatments available and the long-term expectations regarding the patient’s condition.
People who start treatment quickly or have a milder condition tend to heal completely. However, purpura can become chronic in more aggravated situations or in late treatments.
Living together
The aesthetic issue is one of the disorders for patients diagnosed with purpura. Even more so that the stains do not always disappear completely.
In addition, the side effects caused by the use of corticosteroids discourage the patient from starting treatment or cause them to stop the medication.
Some precautions help to stabilize the purple condition:
Avoid drugs that lower platelets
To reduce the chances of having new spots or to make their appearance worse, you should avoid taking medications that reduce the amount of platelets, such as aspirin and ibuprofen.
Light activities
Give preference to low impact activities, in order to avoid injuries, bruises and bleeding, in order to avoid purple.
Personal hygiene
When platelet levels are low, it is recommended to use soft toothbrushes, mouthwashes without the addition of alcohol and to avoid flossing.
In addition, soap, bath sponge and towels must be for individual use. With fragile immunity, this care helps to reduce the risk of contracting bacteria.
Food for those with purple
Some foods are recommended as they increase the number of platelets in the blood. Check out:
Dark green leaves
Examples of dark green leaves include spinach, kale, cabbage and lettuce.
These foods are abundant in vitamin K and minerals that help with bone strength and blood clotting. Its consumption can be made through raw salads, juices or cooked in soup.
Carrots, beets and celery
Such foods are rich in vitamins and minerals that increase the amount of platelets. They can be eaten raw in a salad or cooked. In more severe conditions of infections, another way is to eat it as soup or cream, accompanied by other vegetables.
Fruit
Fruits such as grapes , avocados, bananas , melons and plums are sources of vitamin K, helping to increase platelets. Ideally, they should be ingested in the natural way.
Already fruits like kiwi , strawberry, orange and lemon, are rich in vitamin C and also contribute to the increase in platelets.
Garlic
It is a natural antibiotic and rich in vitamin C.
What to avoid?
Alcohol, aspartame, cow’s milk and quinine (found in tonic water) should be avoided by people with the blood problem.
Complications
Originated by blood clotting problems and without medical supervision, purpura can lead to hemorrhage with the possibility of death.
In uncommon cases, thrombocytopenic purpura without proper treatment can lead to profuse bleeding at locations in the body. Excessive bleeding in the brain can cause fatal cerebral hemorrhage.
In people with Henoch-Schönlein purpura, complications involve kidney damage, and dialysis or transplantation may be necessary, leading to death if left untreated.
It can also cause intestinal volvulus, a rare condition in which there is a twist in the intestine, causing an intestinal obstruction that limits digestion. Without treatment, intestinal obstruction can also cause death.
How to prevent purple?
Because it is associated with certain conditions and pathologies, it is not possible to prevent purple itself. What can be done is to take precautions about the diseases that cause purple.
Common questions
Can purple become leukemia?
Idiopathic thrombocytopenic purpura (ITP) is characterized by a low amount of platelets, generating bruising and spontaneous bleeding.
Its symptoms are similar to those of some oncological diseases, such as leukemias for example. However, PTI is not a cancer .
Can purple kill?
Without treatment or with long onset, the purpura can progress to a hemorrhage, which can cause the death of the patient.
Is purple contagious?
No, purple is not contagious. It is a symptom caused by several factors, but it is restricted to the patient.
Purpura is a disease that has several types. It causes purple spots on the skin and mucous membranes. In children, its disappearance usually occurs spontaneously. In adults, medical monitoring is required.
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