Granulomatous pigmented purpuric dermatoses: report of three cases and review of the literature

Purpuric pigmented dermatoses represent a form of chronic, recurrent capillaritis characterized by petechiae and purpuric macules over the lower limbs. We report three female cases who presented with clinical features of purpuric pigmented dermatosis with unusual histopathologic features. The first patient had golden-brown pigmented purpura over bilateral knees, shins and dorsal feet. The second patient showed purpuric papules on the medial aspects of the ankles. The third patient presented with numerous petechiae on her lower legs. All three patients demonstrated granulomatous inflammation in addition to the histologic features of pigmented purpuric dermatosis. A total of 11 patients have currently been reported in the literature. A review of the clinical details of the cases revealed a high incidence of hyperlipidemia (7/11) and hypertension (4/11) among these patients.