Psychogenic purpura

The history of psychogenic purpura dates back to the early 20th century. In 1927, the German psychiatrist Rudolf Schindler described 16 patients with skin hemorrhages [1]. Shortly thereafter in 1928, 2 other cases were described with associated hysterical personality and delusions, respectively, thus connecting the skin lesions with psychopathology [2].
Initiation of skin lesions generally follows physical trauma or surgery [3] but can be atraumatic in nature [4–7] with the common theme being severe emotional disturbance.
Painful bruising syndrome is characterized by burning, itching, and a stinging sensation or pain, followed by cutaneous induration a few hours later. The patients bruise easily. A recurrent type of eruptions is characterized by extremely painful and tender ill- defined ecchymotic masses on the extremities and sometimes on the face or trunk. Subsequently, painful edematous pink or red plaques of variable sizes become visible in a few hours and resolve within 5 to 8 days.
While the extremities and trunk are common sites, new lesions can occur anywhere on the body [8–10].
Some authors have suggested associations with a variety of hematologic conditions including thrombocytosis, defective thrombocyte aggregation, increases in activated partial thromboplastin time, idiopathic thrombocytopenic purpura, and circulating fibrinolytic factors [11–14], while others consider it to be of psychosomatic or factitious origin as the patients frequently present particular psychological manifestations, hence the name of psychological purpura [9, 13].
Young women bruise easily despite normal coagulation profiles and normal platelet count. Hersle and Mobacken have found some 31 patients reported in the literature.
Conversion symptoms, hysterical traits, and dissociative reactions may accompany such hemorrhagic symptoms [11, 12].
A 20-year-old female presented with a history of recurrent painful bruise-like marks on the upper extremities, face and body for the preceding 6 years. The disseminated lesions on the skin were light brown to yellow in color, had irregular shapes, varied in sizes from a few millimeters to a few centimeters and were clearly isolated from the healthy skin.
The lesions used to appear abruptly and were heralded by a tingling or burning sensation, followed by a few areas of reddish discoloration progressing to ecchymoses within a couple of days. Lesions occurred at intervals of 1–2 months....


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