Introduction:
Senile purpura, also known as solar or actinic purpura, is a benign condition involving recurrent skin bleeding. It usually affects older individuals and is characterized by dark, purple blotches on the sun-exposed areas, especially on the back of the hands, neck, face, and extensor surfaces of the forearm. Actinic purpura is an uncommonly popular finding among the elderly population, especially those with fair skin and who are more sensitive to sun exposure. Its prevalence increases with age and years of exposure to ultraviolet light. It is estimated to be present in about 12 percent of individuals after the age of 50 years and up to 30 percent after the age of 75 years, and it affects both genders equally. The skin tends to become thinner and relatively more elastic as we age. The capillaries that supply the skin also become more fragile and are more prone to damage with minor trauma, which results in bleeding into the underlying tissues. The bleeding also results in the deposition of pigments like hemosiderin, due to which brownish-purple patches are seen in purpura.
What Causes Senile Purpura?
The following reasons are responsible for actinic purpura-
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Aging- The skin is thin and more prone to damage and a major contributor to senile purpura.
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Sun Exposure- Exposure to the sun for a longer period of time can cause damage to the skin and develop senile purpura.
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Medical Conditions- Diabetes, rheumatoid arthritis, and lupus also increase the chances of developing a lesion.
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Medications- Patients who take certain drugs like steroids and blood thinners on a daily basis are more likely to develop purpura. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also contribute to it.
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Ultraviolet Rays- Long exposure to ultraviolet rays make the connective tissue weak, which is responsible for holding blood vessels in their position. Due to this, the blood vessels become fragile, and the red blood cells leak into the deeper layers of the skin, making the purpura appear.
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Trauma- Actinic purpura can develop from minor trauma.
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Cancer- Purpura can also be a side effect of lymphoma and leukemia.
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Other Possible Causes- Chronic stasis (skin inflammation), scurvy, fragile blood vessels, blood clotting disorders, pressure changes during childbirth, trauma and injuries, anticoagulant therapy, and systemic diseases.
What Are the Clinical Features of Senile Purpura?
The following things can describe senile purpura more vividly-
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Senile purpura is characterized by irregularly shaped macules that are 1 to 4 centimeters in diameter and appear dark purple in color with well-defined margins.
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The condition takes three weeks or more to resolve.
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The surrounding skin is thin, inelastic, and pigmented.
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It is associated with sun damage and other signs of aging.
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The lesions in senile purpura can be seen on the forearms' extensor surface and the hands' dorsal aspect.
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They can also appear on the neck and face.
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Other signs of photoaging (dermatoheliosis) are a mild yellow tinge appearance on the skin with leathered wrinkling and false scarring.
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The skin can also appear darker due to hyperpigmentation which is a result of hemosiderosis (excessive accumulation of iron in the tissues).
How Senile Purpura Is Diagnosed?
A physician can diagnose senile purpura by visual examination alone; however, some tests can be helpful to know the etiology of the condition in a particular patient, such as
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Complete blood count.
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Urine test.
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Liver function test.
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Cancer screening.
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Renal function test.
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Erythrocyte sedimentation rate or C-reactive protein (CRP) test.
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Punch biopsy of the skin.
What Are the Complications of Senile Purpura?
Although senile purpura is benign and usually harmless with no serious complications, patients who are on medications for their other medical conditions should consult a physician to assess the chances of drug reactions, and also it is important to undergo an assessment to rule out the chances of thrombocytopenia (lack of platelets), scurvy or any other vascular diseases.
What Are the Treatment Options?
The bruises or patches of senile purpura are usually healed by the body, but if the skin is thin, it may tear and form a lesion at the site. This cut can be treated in the same way as any regular cut. Regular moisturization and avoiding tight clothes are other methods. Anti-aging laser therapy called Nd: YAG laser helps in the treatment of vascular disease, sun-damaged skin, and pigmented lesions. There are certain medications that can be prescribed by a physician, such as
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Topical 0.1 percent retinol can improve the appearance of photodamaged skin.
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Alpha hydroxy acids have been used for the treatment of skin conditions.
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Niacinamide has antioxidant properties and is a form of vitamin B3 that helps improve skin appearance.
How to Manage Senile Purpura in Older Patients?
In older patients, management should be based first on the protection of the skin, followed by medical help, which can be achieved in the following ways-
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Older patients require extra care because their skin is thin and becomes easily dry. Hence moisturizing dry skin is essential.
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Hot baths or frequent baths should be avoided.
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It is helpful to wear long-sleeved cloth to protect the skin from sun damage.
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A dermatologist can be consulted who may prescribe medications to help treat the condition.
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Sunscreens must be used every day to protect the skin from sun damage.
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Exposure to the sun and hot environments for a long period of time should be avoided.
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The use of an umbrella and wearing wide hats are advisable while going out during hot summer days.
Conclusion:
Senile purpura is a common condition among the older population, and it should be addressed properly because the skin of older people is more prone to bleeding and cuts. Although senile purpura is not a serious complication, in elderly patients, it is more important to assess the condition and cares for the skin with different treatment modalities available and also encourage the patients to moisturize their skin daily.
