Juvenile Onset Pigmented Purpuric Dermatosis: A Case of Lichenoid Purpura of Gougerot and Blum in a Young Girl

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In literature, six different types of pigmented purpuric dermatosis, namely “Schamberg’s disease, Purpura of Majocchi, Lichen aureus, Lichenoid purpura of Gougerot and Blum, Eczematoid- like purpura of Doucas and Kapetanakis and Itching purpura”, are described.^[1] Histologically, in all the variants, erythrocyte extravasation with haemosiderin deposition and perivascular lymphocytic infiltrate in the papillary as well as in mid-dermis is seen. A lichenoid pattern of lymphocytic infiltrate is seen in “Lichen aureus and Lichenoid purpura of Gougerot and Blum”.^[2]

Clinically, “Lichenoid purpura of Gougerot and Blum” is characterised by small lichenoid papules which eventually fuse at certain locations to form plaques of various hues,^[3] commonly affecting men of middle age.^[4]

Pigmented purpuric dermatosis is uncommon in children, with a reported prevalence of 0.18% from an Indian tertiary care centre.^[5] Here we present the case of a nine-year-old girl who came to us with a complaint of sudden onset, multiple, dark-coloured, asymptomatic, proximally progressive lesions on bilateral lower legs for 3 months. Initial lesions appeared on the dorsum of the feet. On examination, the female was healthy and cooperative, with no known past medical history or genetic predisposition for skin diseases. Multiple, well-defined, yellow-brown, lichenoid, non-palpable, non-blanchable petechiae were present on the dorsum of bilateral feet [Figure 1]. These petechiae coalesced to form multiple, ill-defined, lichenoid plaques on the extensor aspect of bilateral lower limbs up to the knees [Figure 2]. Routine investigations were within normal limits. No signs of infection were seen.

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Figure 1: Multiple pinpoint, lichenoid purpuras on the dorsum of bilateral feet.

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Figure 2: Multiple purpuras coalescing to form plaques on bilateral lower limbs.

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Dermoscopic examination of plaque in polarised mode and 30X magnification revealed multiple red dots on an orange-brown background [Figure 3]. A 3 mm punch biopsy showed moderately dense superficial perivascular lymphocytic infiltrate with numerous siderophages concentrated in the upper part of dermis, giving a patchy lichenoid pattern. The overlying epidermis showed focal vacuolar changes with irregular hyperplasia [Figure 4].

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Figure 3: Dermo-scopic examination- Multiple red dots on an orange-brown background (polarized, 30x).

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Figure 4: Haematoxylin and eosin, 10x showing diffuse band-like lichenoid lymphocytic infiltrate in upper dermis with abundant siderophores.

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