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• W2051299588 abstract "Persistent pigmented purpuric dermatoses are a group of skin disorders characterized by their course (chronic or persistent), varied clinical picture (macules, papules and plaques) and unknown origin (e.g. contact allergy, pressure, physical training, drugs are suspected). The only common denominator is their histopathological picture. From the histopathological point of view, Dowd and Champion consider them to be capillaritides with similar histopathological picture1 and Scharf also suggests capillaritis.2 Fitzpatrick’s textbook describes extravasation of red cells, haemosiderin in macrophages, lumenal narrowing, endothelial swelling of the superficial small vessels, and perivascular lymphocytic infiltrate (capillaritis is not mentioned).3 Ackerman emphasizes that no persistent pigmented purpuric dermatitis is a capillaritis, because fibrin is not present in the vessel walls and thrombi are not present in the lumina. In addition to this, he draws attention to the fact that persistent pigmented purpuric dermatoses represent one pathological process that coins the names according to its histopathological picture. When lymphocytic infiltrate accompanied by extravasated erythrocytes and siderophages is lichenoid, the diagnosis is lichenoid purpura of Gougerot and Blum; when spongiosis is present, the diagnosis is itching purpura. In addition, purpura annularis telangiectodes of Majocchi is indistinguishable from Schamberg’s disease, as well as lichen aureus is indistinguishable from lichenoid purpura of Gougerot and Blum in histopathological slides.4 From a clinical point of view, there are nine nosological entities under the umbrella of persistent pigmented purpuric dermatoses. The hallmark of all entities is bleeding to the skin, presented as petechiae and ecchymoses (macules) or papules and plaques, which could be red, purple, yellow or brown due to pigments (haemosiderin, biliverdin, bilirubin). The entities are classified by their course (progressive pigmented purpuric dermatosis or Schamberg’s diseases), by symptoms (itching purpura or Ducas–Kapetanakis’ purpura), morphology (pigmented purpuric lichenoid dermatosis of Gougerot and Blum, lichen aureus, purpura annularis telangiectodes of Majocchi, linear and quadratic pigmented purpuric dermatoses), proposed aetiopathology (gravitational purpura) or occurrence (familial pigmented purpuric eruption).1 Furthermore, every entity has synonyms, e.g. itching purpura is named disseminated pruriginous angiodermatitis, eczematide-like purpura, etc.1–3 Do we need so many entities if they are just clinical variations of one pathological disorder? Do we need to study all entities if leading dermatologists consider their distinction to be only arbitrary?1,4 Do we really think that one has to know so many names and definitions to become an experienced dermatologist? What about a practical impact of the knowledge – would it not be better to stress major pitfalls in the diagnostic process? Dermatology is a beautiful branch of medicine, but despite progress in immunodermatology, genetics and bioengineering techniques we still repeat ‘fundamental truths’ that we learned as residents. Why don’t we try to make our discipline more enjoyable and more logical? In sum, persistent pigmented purpuric dermatoses are one nosological entity with clinical variations. Those variations are: (i) macular (Schamberg’s purpura pigmentosa progressiva); (ii) annular (Majocchi’s purpura annularis telangiectodes); (iii) scaly papular (Ducas–Kapetanakis’ itching purpura); and (iv) lichenoid papular (Gougerot–Blum’s lichenoid purpura). Histopathologically, it is a superficial perivascular and interstitial dermatitis (macular and annular variant), a superficial perivascular, interstitial and spongiotic dermatitis (scaly papular variant), and a superficial perivascular, interstitial and lichenoid dermatitis (lichenoid papular variant)." @default.
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• W2051299588 date "2001-01-01" @default.
• W2051299588 modified "2023-10-16" @default.
• W2051299588 title "Persistent pigmented purpuric dermatoses: Who are you?" @default.
• W2051299588 doi "https://doi.org/10.1046/j.1468-3083.2001.00199.x" @default.
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