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Evaluation of purpura in children

Leslie Raffini, MD
Section Editor
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH


Bleeding under the skin or into mucosal membranes is called purpura and may be an innocent finding related to mild childhood trauma or may be the presenting sign of a life threatening disease. Purpura can be subdivided based on size into petechiae (picture 1) and ecchymoses (picture 2) [1]. Pinpoint areas (less than 2 mm) of hemorrhage, which are reddish-purple lesions are called petechiae (picture 1), while larger confluent lesions are referred to as ecchymoses (picture 2). Ecchymoses are commonly called bruises. In some cases, ecchymoses may be tender or raised. In contrast to other erythematous or vascular skin lesions, purpuric lesions do not blanch when pressure is applied to the skin.

Careful evaluation of any patient with purpura is important for early diagnosis and treatment, particularly in children who are ill-appearing. The type, location, and extent of the purpura, along with the overall appearance of the child, will help guide the initial evaluation.

This review will discuss the evaluation of purpura in children. The evaluation of bleeding in children and adults is discussed separately. (See "Approach to the child with bleeding symptoms" and "Approach to the adult patient with a bleeding diathesis".)


Purpura may result from disruptions in vascular integrity (trauma, infection, vasculitis, collagen disorders) or may be due to abnormalities in primary or secondary hemostasis (thrombocytopenia, abnormal platelet function, clotting factor deficiency, or abnormal clotting factor function) [2].

Complex mechanisms maintain vascular integrity and limit the flow of blood when a blood vessel is damaged:


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Literature review current through: Sep 2016. | This topic last updated: Mar 28, 2016.
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