There are patients who present to clinicians with ulcers and painful reticular lesions, usually on the lower extremities, who do not have histopathologic evidence of leukocytoclastic vasculitis. There was great debate 20 years ago about whether these patients had an immunologically mediated vasculitis, an enzymatically mediated coagulopathy, or an idiopathic disease unto itself. At that time, we argued that the clinical presentation could have several etiologies and that it was in the patient's best interest for the physician to make a clinical diagnosis that would encourage consideration of the various possible etiologies. After reviewing our own experience and the literature, we submitted a paper titled "Painful Purpuric Ulcers With Reticular Patterning on the Lower Extremities (PURPLE)." The journal editor responded, "I believe the descriptive title that you have chosen as a new name for an old disease has no place in the title . . . and undoubtedly will penalize the authors in future literature searches and discussions of the disease, atrophie blanche" (Frederick D. Malkinson, MD, written communication, August 17, 1982). We bowed to the editor and retitled the paper using the then-current jargon that emphasized the clinical outcome rather than the clinical presentation.1
Milstone LM, Braverman IM. PURPLE (Oops! Atrophie Blanche) Revisited. Arch Dermatol. 1998;134(12):1634. doi:
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