Elimination of offending medications that suppress clotting and platelet function will reduce or temporarily eliminate symptoms. Reversal of corticosteroid-induced fragility will also occur, but more slowly and not as completely.
Theoretically, topical 0.1% tretinoin cream applied over a prolonged period and combined with complete solar avoidance could partially reverse the process. This treatment is a decision between patient and practitioner after a full discussion of the costs and effort involved.
Conditions That May Simulate Senile Purpura
Similar findings and symptoms occur in the skin with chronic administration of systemic steroids, and in forms of adrenal cortex hyperactivity. Skin alterations are generalized, not focal, and other signs of hypercorticism are present. Local applications of potent topical steroids can simulate findings of senile purpura, and the cause is distinguishable only by history.
ANSWERS TO CLINICAL APPLICATION QUESTIONS
A 65-year-old active sailor presents with a history of progressive bruising of the arms over the past 3 to 4 years. Bruises now occur with such frequency and following such minor trauma that his wife is concerned about some underlying medical problem. Exam reveals large bruises limited to the sun-exposed extensor surfaces of the arms, forearms, and hands. The history and physical findings suggest senile (Bateman's) purpura.
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