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March> 1, 2008

Violaceous Purpuric Plaques on the Lower Extremity—Diagnosis

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Arch Dermatol. 2008;144(3):405-410. doi:10.1001/archderm.144.3.dof70020-f

Microscopic evaluation revealed a bandlike lymphohistiocytic infiltrate with multiple foci of prominent extravasation of red blood cells in the papillary dermis. The epidermis was slightly hyperplastic, lacked significant spongiosis, and was surmounted by hyperkeratotic scale with focal parakeratosis. The lymphocytes lacked cytologic atypia. On the basis of these findings, the lichenoid variant of pigmented purpuric dermatitis (PPD) was favored over the eczematoid variant of Doucas and Kapetanakis. Treatment with clobetasol propionate ointment, twice daily for 2 weeks on, alternating with 2 weeks off, was initiated for a 2- to 3-month trial. This regimen resulted in decreased erythema and flattening of the plaques, which recurred after the clobetasol therapy was discontinued.

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