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Progressive Pigmentary Purpura
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Progressive pigmentary purpura (we will call it PPP) is a group of similar conditions (Schamberg's disease, Lichenoid dermatitis of Gourgerot-Blum, purpura annularis telangiectodes of Majocchi and Lichen aureus). Schamberg's type is the most common, but many experts believe that dividing them into subgroups is artificial.

PPP results in a rusty brown skin discoloration. The brownish patches are unevenly scattered on both sides and may be few or many. Within the patches are tiny red dots that look as if someone lightly sprinkled cayenne pepper on the area. The area is flat, smooth and not scaly. There are no internal symptoms or effects.

PPP usually starts in adult life, is more common in men and may occur in children rarely. In it's most common form it first appears on the lower legs, then will often spread slowly up the legs eventually often going a little on the body and even the palms (hence the name progressive).

PPP really is a group of conditions, and the actually experience of any one patient is unique. PPP usually is only a cosmetic problem, but some people has severe itching, PPP can go away on its own within a few weeks, persist for years, or disappear only to recur again from time to time.

No one knows what causes it, but if a biopsy is done, inflammation is seen around the tiny capillaries in the skin. The blood leaking through the damaged walls forms the little red dots. The iron from the blood "rusts" (turns into hemosiderin) giving the distinct color. A biopsy may be done to confirm the diagnosis.

Occasionally PPP is caused by a reaction to a prescription drug, allergy to clothing dye and rubber, food preservatives and artificial coloring agents, or another skin disease. When it is limited to a few small patches, it may be due to an abnormal veins or arteries underneath. This may need support stockings or surgery to clear it up.

Treatment is not always needed. Itching can usually be controlled with prescription steroid creams. In some cases, especially if fairly potent steroids are used, they may actually clear the PPP completely. More extensive cases can be treated with oral Trental (pentoxifylline). This takes several months, and does not always work. Trental improves circulation, and aside from rare stomach upset, it is a very safe medication. Vitamins have been said to help also (Vitamin C 500mg twice daily and Bioflavonoid Complex with Rutin).

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