Another, new dermatosis in the spectrum of pigmented purpuric dermatoses or atypical variant of lichen aureus?

Pigmented purpuric dermatoses (PPD) are a group of dermatoses with common histopathological findings and diverse clinical presentation. The traditional classification includes six subtypes: lichen aureus, itching purpura, purpura annularis telangiectodes (Majocchi purpura), pigmented purpuric lichenoid dermatitis of Gougerot-Blum, progressive PPD (Schamberg purpura), and eczematid-like purpura of Doucas and Kapetanakis [1]. Nevertheless, there are some descriptions of cases that share the histopathological features of PPD, but the clinical presentation is not typical for any of the above-mentioned entities [2–4]. We describe another atypical case, which is clinically and dermatoscopically similar to the one presented by Zalaudek et al. [4].
A 13-year-old, otherwise healthy, girl presented with a red-brownish plaque on the lower leg near the lateral malleolus (fig. 1 A). The asymptomatic, slowly growing lesion was present for 12 months. The patient denied taking any medications and had no history of trauma of the affected site. The family history was unremarkable. On clinical examination the plaque consisted of 1–2 mm confluent papules covered with a whitish scale. Dermoscopically, the lesion presented a pattern of red and brown irregularly distributed globules and dots and a light-brown reticular network at the periphery interrupted by a white scale in a linear distribution (figs. 1 B–D). The histopathological examination of the lesion revealed psoriasiform hyperplasia of the epidermis with discrete parakeratotic foci and dense, band-like dermal infiltrate composed of small lymphocytes intermingled with scattered siderophages and extravasated erythrocytes. Epidermal lymphocyte exocytosis was not present. CD4+ lymphocytes prevailed slightly over CD8+ cells with a noticeable decrease of CD7 expression. The whole appearance confirmed the diagnosis of PPD (fig. 2). Clinically, it did not match any of the above-mentioned subtypes. Another biopsy performed after 6 months was similar to the former one.
Pigmented purpuric dermatoses is a general term relating to a group of chronic, uncommon dermatoses characterized by similar histopathological features including perivascular lymphocytic infiltration, erythrocyte extravasation and hemosiderin deposition. Apart from the six clinical categories of PPD, some atypical presentations of PPD have been described. There are limited data concerning PPD in the pediatric population. It is known that all clinical...


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