You were probably surprised when you noticed them, because you haven’t bumped into anything, and besides, they don’t itch or hurt. But what are they? Why did they appear?

What are pigmentary and purpuric skin dermatosis?

Also known as capillaritis, pigmentary and purpuric dermatoses (PPD) are a group of benign skin rashes characterized by numerous small, blood-red spots that eventually develop into brown patches. They are different from ruby spots, which you can read about in this article.

They may feel slightly itchy, but unlike bruises, they don’t hurt. They most commonly appear on the legs or feet of adults, although they can also appear in children.

More images of PPD

Why do pigmentary and purpuric skin conditions occur?

Various possible causes for the onset of PPD have been suggested. I will list them below, but the reality is that none of them has been fully proven. In most cases, we are left wondering why it occurred.

The proposed possible causes are:

• poor circulation
• intense exercise
• spending many hours on one’s feet
• infections
• alcohol consumption
• certain medications: DPP has been linked to many medications from various classes.
• chemical exposure
• systemic diseases

How is pigmentary and purpuric dermatosis diagnosed?

Generally, dermatologists can diagnose this condition through a physical examination. Occasionally, we order blood tests to confirm that there are no issues with blood clotting or platelets.

In specific cases or when there is uncertainty, we usually take a skin sample (skin biopsy), which confirms the diagnosis.

How are pigmentary and purpuric skin conditions treated?

Unfortunately, there is no completely effective treatment for this condition. The scientific literature includes reports of cases treated with a wide variety of medications, but none have demonstrated clear effectiveness.

Since it usually causes no symptoms, the rash is often left untreated. In other cases, we recommend measures to promote venous return and prevent leg swelling, or topical corticosteroids to reduce skin inflammation.

Furthermore, although it may be a chronic condition, the spots often disappear on their own after a few weeks, months, or even years. For this reason, we generally opt for a wait-and-see approach.

Different names for this conditon…

Perhaps while reading this article, you’ve realized that this is exactly what’s happening to you; however, your doctor may have used a different term to diagnose you. Don’t be surprised. There are several types of DPP with rather unusual names—whose significance, in my view, is purely academic—which I’ll list below. For simplicity’s sake, they can all be grouped under the umbrella term DPP or capillitis.

The types of DPP are:

• Schamberg’s purpura
• Purpura annularis telangiectodes (Majocchi’s purpura)
• Gougerot-Blum’s pigmented purpuric lichenoid dermatitis
• Lichen aureus
• Eczematous purpura of Doukas and Kapetanakis

Has this ever happened to you? Tell us how it turned out :)

The post Red and brown spots on the skin: pigmentary and purpuric dermatoses first appeared on Dra. LOREA BAGAZGOITIA.

What causes rosacea?

Although we diagnose it frequently and have treatments available to control it, it is striking that we still do not know its exact cause. This is frustrating for both patients and us dermatologists.

Rosacea is considered to be a chronic inflammatory skin disease that evolves in flare-ups. It seems that there may be a certain genetic predisposition; that is, if someone in your family has rosacea, you may be more likely to suffer from it. Simply put, there are two main characteristics: redness and red pimples.

It is known that there are two main factors involved in rosacea. On the one hand, there is increased skin inflammation (related to receptors called TLR-2 (toll-like receptors) and molecules called cathelicidins. On the other hand, it is thought that certain microbes may also play an important role: the mite Demodex folliculorum and the bacterium Bacillus olenorium (which in turn lives in Demodex).

What is demodex folliculorum?

Demodex folliculorum is a mite that lives on our skin. It has eight legs and a tail-like appendage called an opisthosoma. It thrives in areas with high sebum production and is therefore found mainly in the follicular openings (pores) on the face.

We are born without demodex on our skin, and as we grow, they colonize us through contact with other people.

Demodex and rosacea

It has been proven that people with rosacea have a higher number of Demodex mites in their pores than people without rosacea. What is unclear is which came first, the chicken or the egg.

It is unclear whether skin prone to rosacea facilitates the growth of more demodex mites (as it is redder, has more blood flow, which makes it warmer and more comfortable for the mite) or whether these mites cause the inflammation characteristic of rosacea. It is also unknown how much of the blame lies with the mite itself and how much with the bacterium Bacillus olenorium (which colonizes Demodex), as rosacea often improves with antibiotics (antibiotics would destroy the bacteria, but not Demodex).

Pityriasis folliculorum and rosacea

In any case, despite the controversy surrounding the cause, we know that in many cases using a treatment that eliminates demodex can significantly improve rosacea.

This approach has usually been associated with papulopustular rosacea, i.e., rosacea that predominantly appears as red pimples on the cheeks.

However, pityriasis folliculorum is particularly interesting, as it causes a rough skin surface with white “plugs” in each pore in people with the typical redness we attribute to rosacea. These plugs correspond to the opisthosomes of the mite that protrude from the follicular opening.

In these cases, treatment to eradicate Demodex (e.g., ivermectin) indirectly achieves not only the elimination of these “blackheads,” improving texture, but also greatly reduces redness and sensitivity.

Here you can read more about pityriasis folliculorum and demodex.

In conclusion…

The evolution and response of skin redness after treatment for pityriasis folliculorum (which consists of eliminating demodex overgrowth) suggests that this mite is more a cause than a consequence of rosacea.

Demodex would influence not only cases of rosacea with inflammatory pimples, but also less severe cases in which only some redness is visible on the skin.

Do you have redness and roughness on your skin? Did you know about the influence of demodex?

The post Demodex and rosacea: cause or consequence?? first appeared on Dra. LOREA BAGAZGOITIA.