Actinic purpura results from sun-induced damage to the connective tissue of the dermis
Senile purpura, also called actinic purpura, is a benign skin condition that commonly affects older adults. Actinic purpura results from sun-induced damage to the connective tissue of the dermis (deeper layers of the skin) combined with the fact that the blood vessels become thinner and more fragile and collagen decreases with increasing age. Actinic purpura is characterized by ecchymoses (skin discoloration due to bleeding underneath, typically caused by bruising) usually of the skin surfaces of the hands. Women have lesser collagen than men; hence, it’s slightly more common in women than in men.
Individual lesions of actinic purpura usually resolve within one to three weeks but continue to recur. Residual hemosiderosis (iron deposition) in the affected area may occur. The ecchymoses can cause cosmetic concerns and permanent dyspigmentation (change in the skin color) or scarring, but the lesions are not associated with any serious complications. Actinic purpura could be an indication of osteoporosis, a sign of collagen loss in the skin and bone.
How is actinic purpura caused?
Long-term sun exposure and damage to the skin leads to skin changes that increase the risk of actinic purpura. Ultraviolet radiation causes atrophy (progressive degeneration) of the connective tissue of the dermis; hence, the connective tissue is unable to support the small blood vessels in the dermis adequately. Thus, minor trauma or even applying pressure on the skin can cause the blood vessels to tear easily causing bleeding and bruising.
What are the signs and symptoms of actinic purpura?
Macules and patches are lesions seen in actinic purpura that appear dark purple on the skin and are irregularly shaped. Some lesions are darker than others because of their longer duration. There is a sharp demarcation (margin) seen between the borders of the lesions and normal surrounding skin.
Lesions are usually more than 3 mm in diameter and commonly present on the surface of the hands but do not extend onto the fingers. Ecchymoses may also be seen on the face and neck. Other signs of photo-aging (dermatoheliosis) include a mild yellow tinge to the skin, leathered wrinkling, and pseudo scars (false scarring). The skin may appear darker due to hyperpigmentation as a result of residual hemosiderosis.
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How is actinic purpura treated?
Treatment of actinic purpura is mainly conservative. Treatment options include:
- Protection from photodamage: Protective measures against sun damage can prevent or reduce further sun damage and worsening of the condition. Reducing further ultraviolet-induced sun damage involves applying high SPF sunscreens with UV-A and UV-B protection to all exposed areas of the body throughout the year, even if it’s raining or during the winter when it may not seem very sunny. It is also advised to use barrier protection (full-sleeved clothing, covered pants, wide-brimmed hats, etc.) to further reduce the risk of sun damage. Patients with actinic purpura should limit their sun exposure or avoid direct sun exposure altogether.
- Tretinoin: This has been found to reverse several changes that occur as a result of photodamage. Tretinoin increases the amount of collagen in the dermis when applied to the skin. However, applying tretinoin to the actinic purpura lesions does not improve the lesions.
- Laser therapy: Anti-aging laser therapy such as Nd: YAG laser can help treat vascular and pigmented lesions in aging and sun-damaged skin.
Patients are advised to try and avoid any risk of injury to the affected areas.
Can actinic purpura be treated?
Actinic purpura can be managed by adhering to lifelong sun protection measures and starting early such as:
- Avoiding sun exposure when the sun is at its strongest, owing to a high risk of sun damage, that is, from 10 a.m. to 4 p.m.
- Applying sunscreen with UV-A and UV-B protection every day throughout the year
- Wearing protective clothing while outdoors during the day as a method of barrier protection
- Carrying an umbrella or wearing a wide-brimmed hat and sunglasses during the day