What Is Purpura?

Purpura is the term for discolored spots on the skin that develop when small blood vessels leak under the surface. With purpura, you may notice red, purple, or brown spots or patches on your skin or the inside of your mouth (mucous membranes).

Purpura is not a condition but is a symptom with many potential causes, ranging from minor trauma (injury) to medication use or infections to more serious underlying health conditions that affect blood clotting. Treatment for purpura depends on the underlying cause. 

This article explores the types, causes, and symptoms of purpura. It also covers related conditions, the diagnostic process, and treatment options. 

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Types

Purpura types are based on blood platelet levels. Platelets (thrombocytes) are cell fragments that form blood clots to help stop bleeding. There are two main types of purpura: thrombocytopenic and nonthrombocytopenic.

Thrombocytopenic Purpura (TP)

TP occurs when you have a low platelet count (thrombocytopenia), leading to difficulty forming blood clots. Autoimmune disorders, bloodstream infections, certain medications that interfere with platelet production, and some viral infections can lead to this type of purpura.

Nonthrombocytopenic Purpura (NTP)

Platelet counts are normal with nonthrombocytopenic purpura, but other factors—such as weak or inflamed blood vessels, inherited disorders, injury, certain medications, aging, and blood clotting disorders—can cause this type of purpura.

Purpura Symptoms 

Purpura symptoms can vary from person to person, depending on the underlying cause. 

Thrombocytopenic Purpura Symptoms

Thrombocytopenic purpura (TP) is when purple, red, or yellowish-brown spots appear on the skin or mucus membranes (e.g., the lining of the mouth). TP is a symptom of thrombocytopenia, which occurs when your platelet counts are low. Other symptoms of thrombocytopenia are bleeding-related and may include:

• Petechiae, which are tiny, flat red spots under the skin 
• Bleeding gums
• Nosebleeds
• Blood in urine or stool
• Heavy menstrual bleeding 
• Prolonged bleeding, even after minor injuries 

Nonthrombocytopenic Purpura Symptoms

Nonthrombocytopenic purpura is when purple, red, or yellowish-brown spots or patches develop under the skin due to inflammation, damaged blood vessels, or an underlying health condition. Symptoms vary depending on the cause and may include:

• Itchiness on or around the discolored spots 
• Joint pain 
• Abdominal pain 
• Fever or flu-like symptoms
• Diarrhea
• Hives
• Other symptoms associated with the underlying condition 

What Causes Purpura? 

There are many potential causes of purpura, ranging from minor injuries to serious underlying health conditions.

Thrombocytopenic Purpura Causes

Thrombocytopenic purpura (TP) is associated with low platelet counts and an increased risk of bleeding. Causes of TP include: 

• Immune thrombocytopenic purpura (ITP): An autoimmune disorder where the immune system mistakenly attacks and destroys platelets. This results in a reduced number of platelets, leading to purpura and an increased risk of bleeding.
• Thrombotic thrombocytopenic purpura (TTP): TTP is a rare but potentially life-threatening condition where small blood clots form throughout the body, lowering your platelet count and causing purpura.
• Medications: Drugs that reduce platelet counts, such as blood thinners and some chemotherapy drugs, can lead to TP.
• Meningococcemia: A life-threatening bacterial infection that occurs when Neisseria meningitidis bacteria enter the bloodstream.
• Autoimmune disorders: Systemic lupus erythematosus (known as lupus) and other autoimmune and connective tissue disorders can cause purpura. 

Nonthrombocytopenic Purpura (NTP) Causes

Nonthrombocytopenic purpura occurs when platelet counts are within the normal range, but other factors cause blood vessel damage or dysfunction. Causes of NTP include:

• Aging due to thinning skin and more fragile blood vessels (actinic purpura)
• Viral infections, such as cytomegalovirus (CMV), rubella, or Epstein-Barr virus
• Blood vessel inflammation (vasculitis) 
• Certain medications (e.g., corticosteroids) 
• Blood clotting disorders 
• Vitamin C deficiency
• Childbirth (due to blood pressure changes) 

Risk Factors

Certain factors may increase your risk of developing purpura, such as:

• Age: Older adults often have more fragile blood vessels, leading to higher rates of purpura (known as actinic purpura). 
• Sex: People assigned female at birth have a higher incidence of immune-related purpura.
• Family history: A family history of purpura or bleeding disorders is associated with an increased risk of purpura. 
• Certain health conditions: Blood clotting disorders, autoimmune conditions, obesity, being pregnant, and viral infections are associated with developing purpura. 
• Medication use: Taking medications that affect the blood vessels or platelets (e.g., blood thinners, steroids) increases the risk of purpura. 

Diagnosis

To diagnose purpura, a healthcare provider will perform a physical examination and closely examine the affected areas of your skin. Once they confirm the spots are purpura, they will review your medical history, ask whether you have other symptoms, and order diagnostic tests to determine the underlying cause. 

Finding out what is causing purpura is an important step in the diagnostic process. Diagnostic tests that help identify the cause of purpura include:

• Blood tests: A complete blood count (CBC) measures the levels of platelets, white blood cells, and red blood cells.
• Skin biopsy: Involves collecting a small sample of the affected skin to examine under a microscope to confirm or rule out purpura.
• Bone marrow aspiration and biopsy: This involves taking a small sample of your bone marrow to examine. Doing so can help identify potential problems with platelet production.

Treatments for Purpura 

Treatment for purpura depends on the cause. If an underlying condition or infection is causing purpura, treatment will focus on managing the cause, which should help improve purpura spots. 

Thrombocytopenic Purpura Treatments

Treatments for thrombocytopenic purpura aim to increase blood platelet counts or reduce platelet destruction to help prevent bleeding and improve symptoms. Treatment options for thrombocytopenic purpura include:

• Corticosteroids: These anti-inflammatory medications can help suppress your overactive immune response, reducing platelet destruction.
• Intravenous immunoglobulin (IVIG): IVIG contains antibodies that can help raise platelet levels. Intravenous immunoglobulin is a form of injectable IVIG.
• Splenectomy (removal of the spleen): In severe cases where the spleen plays a role in platelet destruction, surgical spleen removal may be considered.
• Thrombopoietin receptor agonists: These are medications that stimulate platelet production. They are often used when other treatments are ineffective.

Nonthrombocytopenic Purpura Treatments

There is no specific treatment for nonthrombocytopenic purpura. Mild cases of NPT often resolve on their own without treatment. Some people may use topical creams containing alpha-hydroxy acid, retinol, and arnica oil to improve circulation and thicken the skin to help improve skin health.

If an underlying condition is causing purpura, treating that condition may help. Treatments may include:

• Stopping or lowering the dose of medications causing purpura 
• Immunosuppressive drugs to treat autoimmune conditions 
• Antibiotics or anti-viral medications to clear infections
• Over-the-counter (OTC) pain relievers and anti-inflammatory medications, such as Tylenol (acetaminophen) and Advil (ibuprofen) to reduce pain and inflammation

Prevention

It is not always possible to prevent purpura because many factors, including underlying health conditions, can cause it. Preventive measures may help protect against certain subtypes of nonthrombocytopenic purpura (e.g., actinic purpura) associated with aging and sun exposure. These include:

• Protect the skin: Wear protective sleeves on the arms to prevent injury and apply sunscreen to sun-exposed skin to protect against ultraviolet (UV) rays. 
• Manage underlying health conditions: Effective management of autoimmune disorders or conditions linked to purpura may help reduce the frequency of purpura. 
• Regular check-ups: Routine check-ups with your healthcare provider to monitor your overall health may help detect potential purpura causes early.

Living With Purpura

Although purpura is benign (harmless), it is sometimes caused by chronic conditions that can affect your overall well-being and quality of life. Following your treatment plan, leaning on friends and family for support, and talking with a mental health professional can help you manage the physical and emotional aspects of purpura and related conditions.

Some people with purpura may feel self-conscious about the appearance of their skin. Wearing clothing that protects and covers the skin or makeup to camouflage the spots may help. Seeking support from loved ones, joining support groups, and engaging in open conversations with healthcare providers can provide valuable encouragement and coping strategies to build self-confidence and embrace self-acceptance.