PURPURA

PURPURA, a term used to denote hemorrhages into the skin, having the appearance of dark red spots and points; morphologically, the concept of P. thus coincides with the concept of petechiae; much more rarely, reference is made to hemorrhages the size of a 10-20 kopeck coin; the concepts of P. and petechiae coincide also in pathogenetic relation, since the main mass of corresponding hemorrhages occurs by diapedesis and falls on infectious-toxic diseases, running with hemorrhagic diathesis. However, when speaking of P., one also often has in mind the abundance of hemorrhages, i.e., the quantitative aspect of the phenomenon. Often P. is used to denote multiple pinpoint hemorrhages into the substance of the brain, for example in purpura cerebri (in some encephalitides, poisoning with salvarsan, etc.). Basically, the term P. is applied to simple eruptions, and clinically they manifest as round, usually small-sized, dark red, rarely coalescing and not disappearing under pressure spots, which during reverse development undergo changes in color, first becoming brown-red, then greenish and yellow. If P. is accompanied by a greater or lesser degree of edema, it is called p. urticata; with marked infiltration, one speaks of p. papulosa; with admixture of abundant exudation and formation of blisters—of p. bullosa. There is no generally accepted classification of P. The main types of P.: p. simplex, p. rheumatica, p. abdominalis, p. fulminans, p. haemorrhagica (see Werlhoff's disease), p. senilis, p. symptomatica. Many authors consider the first four types of P. as variations of one disease (so-called disease of Henoch-Schönlein), differing from each other in 'the degree of spread of the process and its severity.' In view of the similarity of the clinical picture of these forms of so-called idiopathic or essential P. with the anaphylactic symptom complex occurring in serum disease (in both cases there is fever, urticaria, erythema, edema, swelling and pain in joints, intestinal hemorrhages with colic, albuminuria, etc.), Glanzmann proposed to call these P. anaphylactoid, and he divides these anaphylactoid P. as follows: A. Chronic intermittent form: a) p. simplex, b) p. urticans-erythematosa, c) P. with edemas, d) P. with joint manifestations, e) P. with polyneuritis, f) P. with intestinal hemorrhages and colic, g) P. with albuminuria and hemorrhagic nephritis. B. Acute infectious form. C. P. fulminans Henoch's. In p. senilis, the entire clinical picture consists of skin hemorrhages, mainly on the lower extremities and in the lower part of the abdomen, while the general phenomena are either absent or expressed slightly. When P. runs with joint involvement (more often of the knees), one speaks of rheumatic P. (P. rheumatica), and pain in the joints appears either simultaneously or before the skin manifestations, while sometimes there are also hemorrhages into the joints. P. abdominalis—P., accompanied by intestinal hemorrhages and severe pain in the abdomen, sometimes with kidney involvement as well. In P. fulminans, which in some cases is associated with acute infectious diseases (such as scarlet fever, measles, tonsillitis, etc.) or develops suddenly in perfect health, the matter apparently concerns a septic infection, and patients die within a few hours or days. The disease is accompanied by high fever, bloody vomiting, cerebral phenomena, etc. At autopsy—hemorrhages in internal organs, in the meninges, in the brain, etc. P. senilis (Bateman) is observed in persons aged 65 years and older with clear signs of 'senile atrophy of the skin.' The first manifestations of senile P. appear on the back of the hands and on the extensor surfaces of the forearms and manifest as rapidly coalescing brick-red spots, on which after a short time bluish-red hemorrhages form, and then sometimes fine scaling. After 8-10 days, the eruptions begin to regress rapidly, passing through the above-mentioned color changes and leaving pigment spots for several months. Histologically, there is a sharply expressed picture of skin atrophy; elastic tissue disappears almost completely, collagen tissue degenerates, skin vessels are narrowed, their walls are thinned, while around the eruptions veins are dilated and engorged. Symptomatic P. (p. symptomatica) is often observed. Thus, it is often seen in various poisonings (phosphorus, benzene, etc.), in medicinal intoxications [iodoform, quinine, arsenic (salvarsan P.), chloral, balsams, sodium salicylate, antipyrine, etc.], in asphyxia, in acute yellow atrophy of the liver, in blood diseases (in acute leukemia, etc.), in acute and chronic infections [in smallpox (p. variolosa, p. postvaccinalis)], scarlet fever, measles, typhus, influenza, malaria, pneumonias, septic diseases, gonorrhea (p. gonorrhoica), syphilis (p. syphilitica), and sometimes also in typhoid and paratyphoid. Cases of P. after severe physical exertion have been noted. Milian (Mi-) observed P. on the skin of the chest and neck, developing immediately after epileptic seizures. Furthermore, purpuric eruptions occur at the sites of bites of certain insects (at the sites of flea bites—p. pulicosa). Sometimes P. develops in various nervous diseases, both functional and organic (myelitis, tabes, etc.).-P. annularis teleangiectodes Majocchi—see Majocchi's disease. P. scorbutica—see Scurvy.