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74 year old woman with new Purple Patch on her arm worried about melanoma.

What is your diagnosis?

74 year old woman with new dark mole on her arm worried about melanoma
Diagnosis:
Bateman's purpura.

This patient had a new mole and was concerned about melanoma (her aunt died of melanoma) and presented to our clinic for mole evaluation. The clinical picture was clear, but also dermatoscopic evaluation clearly demonstrates the 'dark purple' vascular etiology. She has Bateman's purpura.

Bateman's purpura, also known as actinic purpura, is a very common condition seen in the geriatric setting. It was first described by Dr. Bateman in 1818. Bateman's purpura is a result of changes to the skin as a result of chronic sun exposure. As a result, the dermis thins tremendously and there is less cushioning around the vasculature. Very minor trauma such as bumping a doorknob, table edge, etc., can lead to easy vascular fracture and subsequent ecchymoses/bruising. Many patients will complain of the bruising after such minor trauma. Because it results from thinning of the skin, the analogous term to osteoporosis called dermatoporosis has also been used for the condition. Older and more uncommon is the term Bateman's senile purpura, but I found that my patients do not enjoy me giving them any diagnosis with the term senile in it. The resolving lesions can produce a mild postinflammatory hyperpigmentation. Studies have shown that approximately 10 to 15% of all patients older than 50 years of age have the condition, but once again this is seen most commonly in the setting of extensive sun damage and/or sun changes (dermatoporosis) of the skin.

It is also exacerbated by patient's taking daily aspirin for cardiovascular health and/or prednisone for inflammatory conditions.

TREATMENT: I reassure the patients that it is a benign condition. However, I recommend a topical 12% ammonium lactate cream (Lac-Hydrin cream or AmLactin lotion) to be applied twice daily. The ammonium lactate causes a mild thickening of dermis producing more cushioning for the vasculature and a decrease in the purpura. I tell the patients to use the lotion twice daily and that the change will be slow, that is, a noticeable improvement will be seen in 6 to 12 months. For extreme cases I have the patients wear a protective sleeve called 'dermasaver" (www.dermasaver.com).
Dermasaver

 

Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
www.CrutchfieldDermatology.com


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