An 82-year-old farmer comes to the office due to easy bruising. Over the past year, he has had intermittent bruising on his arms with minimal trauma. The patient has had no bloody or dark-colored stools or other symptoms. He has a history of hypertension and osteoarthritis and had a left total hip replacement several years ago with no postoperative issues. The patient used to drink heavily but has been sober for more than 10 years. He has no family history of bleeding disorders. Vital signs are within normal limits. Physical examination shows no mucosal lesions. Cardiopulmonary auscultation is normal. The abdomen is soft and nontender. Skin findings are as follows:

The lesions are not raised or tender, and the remainder of the skin examination is normal. Laboratory results are as follows:
Which of the following most likely predisposed this patient to this skin condition?

Question

An 82-year-old farmer comes to the office due to easy bruising. Over the past year, he has had intermittent bruising on his arms with minimal trauma. The patient has had no bloody or dark-colored stools or other symptoms. He has a history of hypertension and osteoarthritis and had a left total hip replacement several years ago with no postoperative issues. The patient used to drink heavily but has been sober for more than 10 years. He has no family history of bleeding disorders. Vital signs are within normal limits. Physical examination shows no mucosal lesions. Cardiopulmonary auscultation is normal. The abdomen is soft and nontender. Skin findings are as follows:

The lesions are not raised or tender, and the remainder of the skin examination is normal. Laboratory results are as follows:

Which of the following most likely predisposed this patient to this skin condition?

The lesions are not raised or tender, and the remainder of the skin examination is normal.  Laboratory results are as follows:
 Which of the following most likely predisposed this patient to this skin condition?

Quizplus · Accepted Answer

Senile (solar) purpura is a cutaneous syndrome of older adults characterized by intermittent ecchymotic lesions primarily on the hands and forearms. The lesions arise due to blood vessel fragility after years of sun-related damage to the dermis. Platelet counts and coagulation tests are typically normal; the diagnosis is generally made based on clinical appearance alone. Senile purpura is a benign condition that requires no intervention. Lesions tend to resolve spontaneously within a few weeks, but they occasionally result in residual hyperpigmentation due to hemosiderin deposition. Patients should be advised that oral/topical corticosteroids or anticoagulants can increase the frequency and severity of episodes. (Choice A) Patients with alcoholic liver injury can develop bruising due to thrombocytopenia or coagulation factor deficiency. This elderly patient with a normal platelet count, normal coagulation studies, and bruising limited to the arms and forearms likely has senile purpura. (Choices B and C) Antibiotics and hepatitis C virus are sometimes associated with cutaneous small-vessel vasculitis. This disorder is due to immune complex deposition and is characterized by palpable, rather than nonpalpable, purpura. In addition, cutaneous small-vessel vasculitis is not usually restricted to the forearms and hands. (Choice D) Reduced vitamin C intake can lead to scurvy, which is usually characterized by perifollicular hemorrhage, petechiae, and easy bruising. Lesions are often palpable and are not typically restricted to the forearms and hands. Educational objective: Senile (solar) purpura should be suspected when an older patient has easy bruising limited to the forearms and hands. Lesions arise due to blood vessel fragility after years of sun-related dermal damage. Laboratory studies are generally normal; the condition is benign and requires no treatment. __________

An 82-Year-Old Farmer Comes to the Office Due to Easy