Bateman's Purpura: Purple Blotches, Bruising of Hands and Forearms
Synopsis: The painless bruising often looks like flat blotches that begin with a red coloration, turn purple, darken, then eventually fade.1
Author: Disabled World Contact: www.disabled-world.com
Published: 2010-11-10 Updated: 2020-03-30
Clinically speaking, Bateman's Purpura is described as a weakening of the blood vessels and connective tissues just below the surface of the skin.
Over a number of years, sunlight damages a person's skin and their blood vessels underneath, making the walls of their blood vessels very fragile.
What is Bateman's Purpura?
Bruising on the back of a person's hands and arms is fairly common. When it occurs, dermatologists refer to it as, 'actinic purpura,' 'Bateman's purpura,' or, 'solar purpura.' Thomas Bateman first reported this condition in 1813. Today, Bateman's purpura occurs in about 12% of people over age 50.
Clinically speaking, Bateman's Purpura is described as a weakening of the blood vessels and connective tissues just below the surface of the skin. Because these structures are weakened, they tend to break easily when injury occurs, resulting in a release of blood near the surface of the skin. This pooling of blood appears as large red or purplish blotches on the skin. These red or purple discolorations on the skin do not blanch on applying pressure. They are caused by bleeding underneath the skin.
Fig 2. Purpura on the forearm. Also seen are white areas (stellate pseudoscar) due to former purpura.
The bruising often looks like flat blotches that begin with a red coloration, then turn purple, darken, then eventually fade. The bruises are different from other bruises in various ways; for example - the person usually hasn't experienced an injury in order to cause them, and the bruises are painless not tender. The bruises also last longer than regular ones do, often for a period of a few weeks.
- Solar Purpura - (also known as "Actinic purpura," and "Senile purpura") is a skin condition characterized by large, sharply outlined, 1 - 5cm, dark purplish-red ecchymoses appearing on the dorsa of the forearms and less often the hands.
- Bateman Purpura - Caused by lack of support of blood vessels secondary to old age. Can also be caused by corticosteroid therapy.
The bruises usually happen on the back of a person's hands or forearms when the skin is thin, wrinkly, and sun-damaged.
The bruising is largely experienced by persons who are older; actinic purpura is due to the weakening of a person's blood vessel walls over many years of exposure to the sun. Blood thinners such as coumadin or aspirin, as well as consumption of alcohol, can make the condition worse. Administration of steroids, through the form of a cream, pill, or inhalants such as ashma pumps/puffers, can induce thinner skin and this form of bruising as well. Bateman's purpura is essentially a skin disease associated with people who are older, although it can occur in people from any age group.
The bruising can result from even a very minor trauma, one the person might not even remember. The bruises or, 'ecchymoses,' can appear to be any color from blue to black depending on the age of the bruise. Many times, a number of them are present on each of the person's arm, a characteristic location. The bruises heal with a whitish and irregularly-shaped scar called a, 'stellate pseudoscar.' Bateman's purpura refers to flat and irregular, purple bruising that appears on a person's skin as they age. Bateman's purpura also occurs on skin that has been exposed to the sun such as a person's hands or forearms.
While Bateman's is common, it is not dangerous. Bateman's can also occur in a person's mucus membranes, such as their mouth, or internal organs. Sometimes, medications can also cause the disease because the medications affect the person's blood platelets, resulting in Bateman's purpura. The disease affects women and men equally, although it does affect people with fair complexions more often.
Image shows petechiae and purpura on a foot due to medication induced vasculitis
Causes of Bateman's Purpura
Aspirin, prednisone - an oral, synthetic (man-made) corticosteroid (steroid), and alcohol use can all contribute to the formation of Bateman's purpura. Aspirin and alcohol both thin a person's blood and make it easier to leak into their skin, while prednisone causes a person's blood vessel walls to become more fragile. Bateman's purpura is found most often in people who have skin that is sun-damaged and who are over the age of fifty.
Bateman's purpura is due to the weakening of a person's blood vessel walls. Over a number of years, sunlight damages a person's skin and their blood vessels underneath, making the walls of their blood vessels very fragile. Even slight trauma, such as bumping against something, can cause the walls of the person's blood vessels to break and their blood to leak into their surrounding skin.
Signs and Symptoms of Bateman's Purpura
- Major symptoms of Bateman's purpura include skin that appears both thin and wrinkly, nearly flimsy in appearance, as well as flat and irregular purple lesions on the person's skin as they age.
- The purple lesions or bruises show up on the person's face, neck, forearms, or hands.
- The bruising is not related to either pruritus or pain and they commonly last between one and three weeks.
- The bruises are bigger than three millimeters around and are usually present on the outer surfaces of the person's forearms and the dorsa of the person's hands, but do not extend onto the person's fingers.
- The bruising is present in the area of atrophic and inelastic damaged skin.
- Bateman's purpura may be diagnosed through a clinical examination; a laboratory investigation is only needed if a diagnosis is not readily apparent.
Treating Bateman's Purpura
The use of cosmetics may help to conceal the bruising associated with actinic purpura. Dermablend cosmetics are often recommended for dermatologic conditions like actinic purpura and may be purchased at department stores.
- Application on a daily basis of Retin-A prescription cream, or alpha-hydroxy acid cream, can help to increase the thickness of the person's skin and could help.
- The hormone progesterone in lotion form can help women with actinic purpura.
- Limiting sun exposure can help to improve the health of the skin.
Other treatment of Bateman's purpura can include:
- Vitamin K cream applied to the skin daily
- Daily application of alpha hydroxy-acid lotions
- Application of cosmetics to camouflage the lesions
A fairly new medication known as Purpurex can not only reduce the appearance of existing Bateman's Purpura but also significantly slow the development of others in the future.
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