What is purpura?
Purpura, also called blood spots or skin hemorrhages, refers to purple-colored spots that are most recognizable on the skin. The spots may also appear on organs or mucous membranes, including the membranes on the inside of the mouth.
Purpura occurs when small blood vessels burst, causing blood to pool under the skin. This can create purple spots on the skin that range in size from small dots to large patches. Purpura spots are generally benign, but may indicate a more serious medical condition, such as a blood clotting disorder.
Sometimes, low platelet levels can cause excessive bruising and bleeding. Platelets are the cells that help your blood clot. Low platelet levels may be inherited or genetic, but they may also be related to recent:
- bone marrow transplants
- stem cell transplants
- HIV infections
- hormone replacement
- estrogen therapies
- use of certain medications
You should always contact your doctor if you notice any growths on or changes to your skin.
There are two kinds of purpura: nonthrombocytopenic and thrombocytopenic. Nonthrombocytopenic means that you have normal platelet levels in your blood. Thrombocytopenic means that you have a lower than normal platelet count.
The following could cause nonthrombocytopenic purpura:
- disorders that affect blood clotting
- certain congenital disorders, present at or before birth, such as telangiectasia (fragile skin and connective tissue) or Ehlers-Danlos syndrome
- certain medications, including steroids and those that affect platelet function
- weak blood vessels
- inflammation in the blood vessels
- scurvy, or a severe lack of vitamin C
The following could cause thrombocytopenic purpura:
- medications that prevent platelets from forming or that interfere with normal clotting
- drugs that cause the body to launch an immune reaction against platelets
- recent blood transfusions
- immune disorders such as idiopathic thrombocytopenic purpura
- an infection in the bloodstream
- infection by HIV or Hepatitis C, or some viral infections (Epstein-Barr, rubella, cytomegalovirus)
- Rocky Mountain spotted fever (from a tick bite)
- systemic lupus erythematous
Your doctor will examine your skin to diagnose purpura. They may ask about your family and personal health history, such as when the spots first appeared. Your doctor may also perform a biopsy of the skin in addition to blood and platelet count tests.
These tests will help assess whether or not your purpura is a result of a more serious condition, such as a platelet or blood disorder. The levels of platelets can help identify the cause of the purpura and will help your doctor determine the best method of treatment.
Purpura can affect both children and adults. Children may develop it after a viral infection and can usually recover completely without any intervention. Most children with thrombocytopenic purpura fully recover within several months of the disorder’s onset. However, in adults, the causes for purpura are usually chronic and require treatment to help manage symptoms and keep platelet counts within a healthy range.
The type of treatment your doctor will prescribe depends on the cause of your purpura. Adults diagnosed with mild thrombocytopenic purpura may recover without any intervention.
You will need treatment if the disorder causing purpura doesn’t go away on its own. Treatments include medications and sometimes a splenectomy, or surgery to remove the spleen. You may also be asked to stop taking medications that impair platelet function, such as aspirin, blood thinners, and ibuprofen.
Your doctor may start you on a corticosteroid medication, which can help increase your platelet count by decreasing the activity of your immune system. It usually takes about two to six weeks for your platelet count to return to a safe level. When it does, your doctor will discontinue the drug.
If your type of purpura is causing severe bleeding, your doctor may give you an intravenous medication called intravenous immunoglobulin (IVIG). They may also give you IVIG if you need to increase your platelet count rapidly before surgery. This treatment is usually effective in increasing your platelet count, but the effect is usually only in the short term. It can cause side effects such as headache, nausea, and fever.
Other drug therapies
The latest drugs used to treat low platelet count in people with chronic immune (idiopathic) thrombocytopenic purpura (ITP) are romiplostim (Nplate) and eltrombopag (Promacta). These medications cause bone marrow to produce more platelets, which reduces the risk of bruising and bleeding. Potential side effects include:
- joint or muscle pain
- increased risk of blood clots
- acute respiratory distress syndrome
Biologic therapy, such as the drug rituximad (Rituxan), can help decrease the immune system response. It’s mostly used to treat patients with severe thrombocytopenic purpura and patients for whom corticosteroid treatment isn’t effective. Side effects may include:
If medications aren’t effective in treating thrombocytopenic purpura, your doctor
However, splenectomies aren’t effective in everyone. The surgery also comes with risks, such as a permanently increased risk of infection. In emergencies, when purpura causes extreme bleeding, hospitals will perform transfusions of platelet concentrates, corticosteroids, and immunoglobulin.
Once treatment is started, your doctor will monitor your platelet count to help determine whether or not it’s effective. They may change your treatment depending on its efficacy.
The outlook for purpura depends on the underlying condition causing it. When your doctor confirms a diagnosis, they’ll discuss treatment options and the long-term outlook for your condition.
In rare cases, thrombocytopenic purpura that’s left untreated may cause a person to develop excessive bleeding in some part of their body. Excessive bleeding in the brain can lead to a fatal brain hemorrhage.
People who start treatment right away or have a mild case often make a full recovery. However, purpura can become chronic in severe cases or when treatment is delayed. You should see your doctor as soon as possible if you suspect you have purpura.
Living with purpura
Sometimes the spots from purpura do not go away completely. Certain medications and activities can make these spots worse. To reduce your risk of forming new spots or making spots worse, you should avoid medications that reduce platelet count. These medications include aspirin and ibuprofen. You should also choose low-impact activities over high-impact activities. High-impact activities can increase your risk of injury, bruising, and bleeding.
It can be difficult to cope with a chronic condition. Reaching out and talking with others who have the disorder can help. Check online for support groups that can connect you with others who have purpura.