Senile purpura
Introduction
Introduction to senile purpura Senile Purpura is a chronic vascular hemorrhagic vascular hemorrhagic disease that is more common in men and women over the age of 60. Its pathogenesis is mainly related to the skin, subcutaneous tissue and the blood vessel wall itself. The patient's skin undergoes senile degeneration, collagen and elastin gradually disappear, subcutaneous adipose tissue shrinks and relaxes, causes small blood vessels to lose support, and blood vessel fragility increases, leading to local bleeding tendency. The diameter of the bleeding spot is l~4cm, which occurs after minor trauma. Bleeding is common in exposed areas, such as the face, neck, lower arms, hands and calves with purple spots, dark red or purple. The purple spot absorbs slowly, often leaving a brown pigmentation. Older patients with malnutrition or hypertension have clinical bleeding symptoms. basic knowledge The proportion of illness: 0.03%--0.095% Susceptible people: good for the elderly over 65 years old Mode of infection: non-infectious Complications: multiple plaque pigmentation
Cause
Causes of senile purpura
Skin degeneration (35%):
This disease is caused by a high degree of senile slow degeneration in the skin of the elderly, tissue relaxation, lack of collagen tissue around the small blood vessels, loss of subcutaneous fat and elastic fibers, increased capillary wall brittleness, resulting in slight capillary and small blood vessels Mild trauma can cause rupture, and hemorrhage forms purpura. It has been found that with the increase of age, the vitamin C content in plasma and white blood cells is progressively reduced, reaching the lowest value at the age of 60. This physiological change makes the elderly easier. Prone to bleeding.
Cell phagocytosis is reduced (25%):
The phagocytic ability of the phagocytic cells in the tissue is weakened, so the blood absorption is slow, and the hemosiderin is often left in the extravasation of the cells, thus repeatedly becoming a chronic recurrent disease. Thus, the ability of phagocytic cells has a great influence on blood absorption.
Subcutaneous tissue atrophy (25%):
Due to aging, the skin is loose and the skin, the subcutaneous tissue is atrophied, the blood vessels lose support and lack elasticity. A slight trauma can cause rupture of blood vessels and extravasation of red blood cells.
Prevention
Senile purpura prevention
Take prevention as the main, such as protecting the limb from trauma, and prolonging the local compression time after venipuncture to reduce the occurrence of bleeding.
Complication
Senile purpura complications Complications, multiple plaque pigmentation
After the purpura retreats, there is a long strip of pigmentation, the skin of the lesion is thin, lack of elasticity, and the hair is sparse or even lacking.
Symptom
Symptoms of senile purpura Common symptoms Skin purpura purpura skin pigmentation deepens
The patients are middle-aged and elderly, especially those older than 65 years old. Even in the daily life, such elderly people may have purpura if they are slightly traumatic, such as ginseng pressure for 1 to 2 minutes. Female patients seem to be more than males. It mainly occurs in exposed parts that are vulnerable to trauma, such as the back, forehead, calf, upper chest V-shaped area and forearm extension, and occasionally also on the face, especially the contact between the nose and the frame, usually symmetrical, cuff Tests can often be positive.
Early stage of the affected area may have vasodilatation, followed by purpura or limited local purpura, which is irregular in shape and varies in size from needle cap to palm. Due to lack of inflammatory response, the color of purpura often changes little and the realm is clear. It is dark purple and can last for several weeks or longer. The purplish remnants leave long strips of pigmentation, the skin of the lesion is thin, lack of elasticity, and the hair is sparse or even lacking.
Examine
Examination of senile purpura
1. The clotting time is normal, and the beam arm test is mildly positive.
2. Peripheral blood: Platelets are normal.
3. Bone marrow: The megakaryocytes are normal.
4. Tissue biopsy: the skin of the lesion is atrophied, the upper part of the dermis is degenerated by elastic fibers and the lower part is atrophied, the collagen fibers are loose, and the bundle is separated. The venous rupture of the red blood cells is normal and the capillary appearance is normal, and there is no inflammatory reaction.
Diagnosis
Diagnosis and diagnosis of senile purpura
diagnosis
(1) Laboratory inspection
(1) The platelet count is normal.
(2) The hemostasis function is normal.
(3) Capillary fragility test is positive.
(two) diagnostic criteria
(1) More common in older men or women over the age of 60.
(2) skin purpura, about 1 to 4 cm in diameter, more common in exposed parts, such as the face, neck, lower arms, hands and calves.
(3) Some affected skin has atrophy.
(4) The platelet count is normal.
(5) The beam arm test is positive.
(6) The hemostasis function is normal.
(three) diagnosis
1. Characteristics of the disease: mainly seen in the elderly, no obvious history of exogenous, recurrent, the incidence is related to emotional, chronic illness, fatigue and other factors. Bleeding is only seen in the skin and is more common in exposed areas.
2. Symptoms:
(1) The skin appears bluish spots and plaques.
(2) It is more common to extend the back of the hand, neck and upper limbs.
(3) A history of chronic recurrent episodes.
(4) In addition to skin purpura, there is very little visceral bleeding.
Differential diagnosis
(1) Erysipelas: It is within the scope of surgical skin diseases and is named after the skin color such as red dan. The lightness of the light is faded, and the color of the heavy ones does not fade, but the local skin is hot and swollen.
(B) rash: its common point with the purple spot is that there are local skin changes. However, the spot of purple spot is hidden in the skin, it has not faded, and it does not hinder the hand; while the rash is higher than the surface of the skin, the fading of the pressure, the care of the hand.
(C) primary thrombocytopenic purpura: manifested as skin and mucous membrane bleeding, sometimes with nasal discharge, gums, severe cases may have blood in the stool, hematuria, vomiting blood, and even cerebral hemorrhage. In laboratory tests, platelet counts were reduced, bleeding time was prolonged, blood clot retraction was poor at 24 h, and megakaryocytes in the bone marrow were qualitatively and quantitatively altered.
(4) Infectious purpura: purpura caused by vascular damage caused by infection. The mechanism is that the pathogen directly damages the vascular endothelium, and may also directly damage the capillary wall due to bacterial toxin or autoimmune reaction, as well as bleeding caused by factors such as vasculitis and bacterial embolism. The hemostasis function of this disease is normal, and the capillary fragility test is positive. If there is diffuse intravascular coagulation, abnormal blood coagulation mechanism may occur. Clinically, skin ecchymoses and blemishes may be seen, and may be fused into a piece. In severe cases, diffuse intravascular coagulation is accompanied. .
(5) Drug-induced vascular purpura: occurs after the use of some drugs, skin bleeding points, but there is no change in platelet quality and quantity. According to the current research, it may be that the specific anti-vascular antibody occurs after taking the drug, and the immune complex causes the damage of the vascular endothelium; or the long-term use of steroid corticosteroids enhances the catabolism of the protein, and the skin and the tissue are atrophied. The fragility of the blood vessel wall increases and causes purpura in the skin. The disease is positive for capillary fragility test and normal for hemostasis.
