skin ecchymosis
Introduction
Introduction Extensive or localized skin and submucosal hemorrhage, forming red or dark red spots on the skin and mucous membranes, about 3 to 5 mm in diameter or larger, and more than 5 mm is called ecchymosis. For the skin and mucous membrane hemorrhagic patchy lesions, the nature of the same bleeding point, more suggestive of blood diseases or diseases caused by bleeding, abnormal blood clotting. The clinical manifestations are bleeding points, purpura and ecchymoses, which are generally not higher than the skin surface. They can only be slightly bulged when allergic purpura is present. They begin to be purple-red, the pressure does not fade, and then gradually becomes lighter, and becomes yellow after two weeks and subsides. .
Cause
Cause
1. Extravascular factors: If the perivascular tissue is weak due to degeneration, atrophy and relaxation, it is prone to bleeding and form purpura. Extravascular factors are more common in senile or cachexia purpura. Capillaries and small blood vessels are slightly affected by a slight external force, which can cause rupture and hemorrhage.
2. Vascular factors: refers to the purpura formed by the leakage of blood from the blood vessels to the outside of the blood vessels due to damage of the capillary wall. Purpura caused by vascular factors accounted for the first place in all purpura. After a small blood vessel injury in a normal person, the blood vessel immediately undergoes a reflex contraction, and the local blood flow is slowed down to promote hemostasis. If the peripheral blood vessels are brittle, the permeability is increased, and the vasomotor function is abnormal, it is easy to cause hemorrhagic purpura due to extravasation of blood from the blood vessels. The hemorrhage caused by vascular factors is characterized by capillary fragility test, but the bleeding time and clotting time are normal. The most common form of such purpura is allergic purpura. Second, bacterial or viral infections, vitamin C deficiency, chemical factors, etc. can cause damage to the blood vessel wall and cause purpura. In addition, there is an unclear increase in the brittleness of the blood vessel wall, which is common in women. The purpura can disappear on its own and has no adverse consequences. It is called simple purpura.
3. Platelet factors: Platelets play an important role in the process of hemostasis. Thrombocytopenia or defects in platelet function may result in decreased or lost hemostasis, and are prone to purpura. Thrombocytopenia can be seen in idiopathic thrombocytopenia, secondary thrombocytopenia (also known as symptomatic purpura, thrombocytopenia due to bone marrow hematopoietic disorders, seen in aplastic anemia, leukemia, cancerous bone metastasis), radiation Substances and chemicals destroy megakaryocytes, which reduce platelet production and severe infections (such as typhoid fever, meningitis, sepsis) and excessive platelet destruction. In addition, hypersplenism, lupus erythematosus, uremia, etc. can also reduce thrombocytopenia. Platelet function-deficient diseases include hemorrhagic thrombocytosis and thrombocytopenia. Laboratory tests are important for the diagnosis of purpura caused by platelet factors, generally characterized by prolonged bleeding time, poor clot retraction and thrombocytopenia.
4. Coagulation factor: Coagulation factor deficiency often causes coagulopathy and causes purpura. These diseases are rare, the causes are mostly congenital, and a few are acquired (mainly caused by liver disease). Patients with purpura should be examined for blood routine, platelet count, bleeding time, clotting time, capillary fragility test, skin and mucous membrane microcirculation, hemorheology and coagulation factors.
Examine
an examination
Related inspection
Bone marrow analysis, blood biochemistry, six examinations, bone marrow hyperplasia, blood routine
1. Vascular purpura: very common, due to damage to the blood vessel wall or its fragility and permeability, common in immune (such as allergic purpura), infectious (such as sepsis), abnormal vascular structure (such as Hereditary hemorrhagic telangiectasia and other diseases such as abnormal proteinemia, simple or senile purpura. Check that there is no abnormality other than the beam arm test may be positive.
2. Platelet abnormal purpura: the most common, mostly due to thrombocytopenia, increased and dysfunction, if the buccal mucosa of the oral cavity has purpura or blood blister, often suggesting severe bleeding, should be actively treated.
3. Coagulation mechanism disorders: including clotting factor deficiency, anticoagulant substances in the circulation or hyperfibrinolysis, generally caused by blood clotting mechanism disorders, mainly manifested as joint blood, muscle hematoma and visceral hemorrhage, less skin Purpura, only when it appears as a large ecchymosis, and check the coagulation has obvious abnormalities, which can be differentiated from purpura caused by vascular purpura and platelet abnormalities. The treatment of purpura varies according to the cause.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Whole body skin congestion: Whole body skin congestion refers to the expansion of the cutaneous capillaries of the whole body. The dilated blood vessels are mostly small veins or small arteries, and red silky, reticular or stellate lesions appear on the skin. Make the whole body skin congestion, redness and swelling.
2. Pigmented spots: mixed sputum sputum cells and sputum cells nest in the deep layer of the epidermis also in the dermis are called mixed sputum. Common central bulge highlights the leather surface, long hair, surrounded by diffuse distribution, different color, unclear boundary, is the boundary composition, the junction from childhood to the skin ,, so the elderly are rare mixed . Both mixed sputum and junction sputum may have malignant changes.
3. Discoid erythema: Discoid lupus erythematosus (DLE) is a chronic recurrent disease that mainly invades the skin and is characterized by well-defined red plaques (erythema), hair follicle embolism, scales, telangiectasia, and skin atrophy. The cause is unclear. More common in women, the highest incidence rate around 30 years old. The disease can be divided into two types:
1 Limited skin damage is limited to the skin above the neck.
2 disseminated skin lesions affect the skin of a wide range of parts of the body. Some authors believe that the disseminated type is easily converted to systemic lupus erythematosus.
4. Facial butterfly erythema: Facial butterfly erythema is a facial symptom of systemic lupus erythematosus. Lupus erythematosus is an autoimmune disease with slow onset, insidious attack, diverse clinical manifestations, and a variety of autoimmune diseases involving many systems and organs. It produces a variety of autoantibodies due to cellular and humoral immune dysfunction. . It can affect the skin, serosa, joints, kidneys and central nervous system, and is characterized by autoimmunity. There are many autoantibodies in patients, which not only affects humoral immunity, but also affects cellular immunity, and the complement system also changes.
5. Coffee spot: Coffee spot, also known as coffee milk spot, is a light brown plaque that can be found at birth. The color varies from light brown to dark brown, but the color of each piece is the same and very uniform, and the depth is not affected by the day. The effect of the sun varies from a few millimeters to tens of centimeters, the border is clear, and the surface texture is completely normal.
