Dermatologic Differential Diagnosis.pdf. - Famona Site

Calciphylaxis
Chronic renal failure – ecchymoses Lancet ii:1205–1208, 1988;
splinter hemorrhage Ghatan p.84, 2002, Second Edition
Coagulopathy – coagulation defects usually present with large
ecchymoses without petechiae Rook p.2143, 1998, Sixth
Edition
Cryofibrinogenemia Am J Med 116:332–337, 2004
Cryoglobulinemia – ecchymoses, palpable purpura JAAD
48:311–340, 2003; JAAD 13:636–644, 1985
Cushing’s syndrome Ped Derm 15:253–258, 1998
Cystic fibrosis – splinter hemorrhages Ghatan p.85, 2002,
Second Edition
Diabetes mellitus – hemorrhagic callus
Dysproteinemias
Cryofibrinogenemia
Cryoglobulinemia
Hypergammaglobulinemic purpura of Waldenström JAAD
23:669–676, 1990; Acta Med Scand 266 (Suppl):931–946,
1952
Hyperglobulinemia (polyclonal) due to sarcoid, lupus
erythematosus, Sjögren’s syndrome, myeloma
Lambda light chain vasculopathy
Ethyl malonic aciduria and normal fatty acid oxidation –
petechiae J Ped 124:79–86, 1994
Galactosialidosis – autosomal recessive; combined deficiency
of β-galactosidase and neuraminidase; due to defect of
lysosomal protein (prostective protein); angiokeratoma corporis
diffusum; macular cherry red dots and petechia; conjunctival
telangiectasia, telangiectasias of joints, Mongolian-like spots,
café au lait macules, skin hyperextensibility, nevus of Ito
BJD 149:405–409, 2003
Gamma heavy chain disease
Hemochromatosis – splinter hemorrhages Ghatan p.85, 2002,
Second Edition
Hemophilia
Hemorrhagic disease of the newborn JAAD 37:673–705, 1997
Hereditary clotting factor deficiencies JAAD 37:673–705, 1997
Hypothyroidism – purpura and ecchymoses JAAD 26:885–902,
1992
Hypothrombinemia (vitamin K deficiency) Ghatan p.106, 2002,
Second Edition
Idiopathic thrombocytopenic purpura
Kwashiorkor
Liver disease, acute or chronic Rook p.2148,2724, 1998, Sixth
Edition; splinter hemorrhage Ghatan p.84, 2002, Second
Edition; chronic active hepatitis – allergic capillaritis, splinter
hemorrhages Ghatan p.167, 2002, Second Edition
Mitral stenosis – splinter hemorrhages Ghatan p.85, 2002,
Second Edition
Multiple sclerosis – splinter hemorrhages Ghatan p.85, 2002,
Second Edition
Myxedema
Neonatal purpura fulminans – ecchymoses of limbs at sites of
pressure in first day of life; enlarge rapidly, hemorrhagic bullae
with central necrosis; homozygous protein C or protein S
deficiency Semin Thromb Hemost 16:299–309, 1990
Paroxysmal nocturnal hemoglobinuria – petechiae,
ecchymoses, red plaques which become hemorrhagic bullae
with necrosis; lesions occur on legs, abdomen, chest, nose,
and ears; deficiency of enzymes – decay-accelerating factor
(DAF) and membrane inhibitor of reactive lysis (MIRL)
AD 138:831–836, 2002
PURPURA 549
Platelet abnormalities – immune platelet
destruction – post-transfusion, antilymphocyte globulin,
idiopathic thrombocytopenic purpura (ITP), marrow transplant,
alloimmune neonatal thrombocytopenia, maternal autoimmune
thrombocytopenia (ITP, lupus), drug-related immune
thrombocytopenia; primary platelet production/function defects –
bone marrow aplasia, thrombocytopenia with absent radii
syndrome, Wiskott–Aldrich syndrome, Fanconi syndrome,
congenital amegakaryocytic thrombocytopenia, giant platelet
syndromes (Bernard–Soulier, May–Hegglin), trisomy 13 or 18,
Alport syndrome variants, gray platelet syndrome, Glanzmann
thrombasthenia, Hermansky–Pudlak syndrome – all are causes of
neonatal purpura JAAD 37:673–705, 1997; thrombocytopenia –
bone marrow aplasia, uremia, alcohol, drugs, leukemia,
lymphoma, myeloma, myelofibrosis; consumption –
hemolytic–uremic syndrome, thrombotic thrombocytopenic
purpura; hypersplenism; abnormal platelet function;
thrombocytopenia – usually demonstrates petechiae;
thrombopathia, thrombasthenia, von Willebrand;s disease,
severe anemia, fibrinogen; thrombocythemia – livedo
reticularis, acrocyanosis, erythromelalgia, gangrene,
pyoderma gangrenosum Rook p.2142–2145, 1998,
Sixth Edition
Porphyria – itching purpura-like dermatitis Arch Klin Exp Derm
223:128–135, 1965; erythropoietic protoporphyria Eur J Pediatr
159:719–725, 2000; J Inherit Metab Dis 20:258–269, 1997;
BJD 131:751–766, 1994; Curr Probl Dermatol 20:123–134,
1991; Am J Med 60:8–22, 976; splinter hemorrhages Ghatan
p.85, 2002, Second Edition
Prolidase deficiency – autosomal recessive; skin spongy
and fragile with annular pitting and scarring; leg ulcers;
photosensitivity, telangiectasia, purpura, premature graying,
lymphedema Ped Derm 13:58–60, 1996; JAAD 29:819–821,
1993; AD 127:124–125, 1991; AD 123:493–497, 1987
Protein C deficiency with purpura fulminans – necrotic purpura
in neonatal protein C deficiency Pediatr Hematol Oncol
18(7):453–458, 2001; AD 124:1387–1391, 1988
Protein S deficiency – purpura at IV site
Pulmonary disease – splinter hemorrhages Ghatan p.85, 2002,
Second Edition
Purpura fulminans – post-scarlet fever, meningococcal, protein
C or S deficiency Rook p.2191, 1998, Sixth Edition; neonatal –
purpura or cellulitis-like areas evolving into necrotic bullae or
ulcers Textbook of Neonatal Dermatology, p.151, 2001
Scurvy – large ecchymoses and fresh hemorrhage; perifollicular
hemorrhage with hemosiderin staining of legs; hemorrhagic
gingivitis, stomatitis, epistaxis Cutis 66:39–44, 2000; JAAD
41:895–906, 1999; AD 120:1212, 1984; NEJM 314:892–902,
1986; palpable purpura AD 139:1363–1368, 2003; upper eyelid
ecchymoses Arch Ophthalmol 117:842–843, 1999; splinter
hemorrhages Ghatan p.85, 2002, Second Edition
Sickle cell anemia
Splenomegaly – platelet sequestration
Thrombocytopenia – congenital; idiopathic
thrombocytopenic purpura; drug hypersensitivity, posttransfusion,
DIC, Kassabach–Merritt syndrome, prosthetic
heart valves, thrombotic thrombocytopenic purpura, uremia;
aplastic anemia, bone marrow suppression; functional platelet
disorders (Bernard–Soulier syndrome, Glanzmann’s disease,
storage pool disease, von Willebrand’s disease)
Thyrotoxicosis – splinter hemorrhages Ghatan p.85, 2002,
Second Edition
Uremia – also uremic stomatitis – purpuric
Vitamin A intoxication – ecchymoses Rook p.2656, 1998,
Sixth Edition; NEJM 315:1250–1254, 1986