Chronic lesions on legs
The rash was asymptomatic and had developed over the past few years. The patient wasn’t taking any prescriptions and hadn’t changed detergents.
Biopsy confirms diagnosis
Platelet and clotting studies are usually normal with Schamberg’s purpura. The definitive diagnosis can be confirmed through skin biopsy, which shows capillaritis of dermal vessels. Perivascular inflammatory infiltrates with extravasations of blood cells and hemosiderin-laden macrophages are seen on histologic evaluation.
Treat mild itching with corticosteroids
These lesions pose mostly a cosmetic problem, but mild itching and scaling occasionally occur. These symptoms can be treated with topical corticosteroid therapy.
Treatment with an 8-week course of pentoxifylline (Trental)—400 mg daily—has shown resolution of lesions in some patients, but no benefit in others.5,6 In some patient’s, psoralen plus ultraviolet light therapy has been shown to provide modest improvement.7 Treatment with aminaphtone 75 mg bid for 4 weeks has recently shown improvements in patients with longstanding Schamberg’s purpura.8 A review of medications may point to a possible etiology for some patients.9
Although lesions can persist for years, the lesions may eventually clear and patients should be assured that there is no definitive underlying systemic disease associated with Schamberg’s disease.10
Educating our patient
Our patient required no treatment, because his rash was asymptomatic. We told him that the pigmentation can last for years, but could be covered with cosmetics. We also reassured him that no underlying systemic disease had caused his rash.
CORRESPONDENCE Jay Shubrook, DO, Castrop Center, O’Bleness Health System, 75 Hospital Drive, Athens, OH 45701; shubrook@ohio.edu
