To the Editor.—
The mechanisms responsible for purpura are diverse and, in some instances, not completely understood. Generally, the causes of purpura can be classified into vascular defects (either primary or secondary), platelet abnormalities, and coagulopathies.1 One example of secondary vascular purpura is the one that may occur in the loose tissues of the face and neck after violent or prolonged coughing or vomiting or Valsalva's maneuver.2 Crops of petechiae appear but are of cosmetic importance only. The eruption gradually subsides without treatment.
Report of a Case.—
A healthy 45-year-old man was examined for an asymptomatic dermatitis of one week's duration that was confined to the periorbital areas, the glabella, and the upper part of the bridge of the nose. The skin lesions were first noted by his physician during a physical examination that included pneometry. Further questioning disclosed that his physician had not noticed the lesions until