By Gary M. White, MD
Red, purple spots occur suddenly on the older person's skin. Often, the patient is worried about melanoma (which in contrast is usually brown and/or black).
Solar, age-related, or senile purpura (SP) are all terms used to describe the subcutaneous bleeding that develops easily on the arms of the elderly.
Lesions initially are blood-red. Over the ensuing days, the patches turn blue-purple. After several weeks, they totally fade. The extensor arms are the most commonly affected.
Benign, age-related purpura is extremely common. Always consider steroid-induced purpura however. Inquire about all sources of steroids including oral, topical, and intralesional, e.g., knees every 4 months. Cushing's disease is extremely rare but may be considered if the purpura is associated with a buffalo hump, moon facies, new onset hypertension, proximal muscle weakness, and hirsutism [AD 1999;135;474]. If the patient is worried about melanoma, s/he just has to wait 2 weeks, as individual lesions of SP resolve spontaneously.
Patients should try to minimize trauma to the skin. Sun exposure long-term can aggravate the condition so sunscreen is recommended.
Daily supplementation with citrus bioflavenoid complex to reduce SP is supported by one study. A six-week, randomized, multicenter, placebo-controlled, double-blind study of seventy patients with senile purpura with citrus bioflavenoid complex taken orally twice daily was performed. At the end of six weeks, the citrus bioflavonoid blend treated group showed a 50 percent reduction in purpura lesions [J Drugs Dermatol. 2011 Jul;10(7):718-22].
Of note, there is a single case report of an 87-year-old man with serum DHEA in the lower end of the normal range and monthly skin tears taking 50 mg of DHEA daily [JAAD Case Reports 2017;3;534–535]. Before therapy, he experienced monthly skin tearing. Within 1 month of starting therapy, his skin tearing ceased. 18 months of follow up showed no skin tears and no side effects. It might therefore be reasonable to take DHEA to prevent solar purpura as well.
Solar purpura (purple spot) next to a stellate pseudoscar (white spot).
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