An approach to the patient with retiform purpura

Ashley Wysong, Priya Venkatesan

Research output: Contribution to journalReview articlepeer-review

35 Scopus citations


Retiform purpura consists of branching purpuric lesions caused by a complete blockage of blood flow in the dermal and subcutaneous vasculature. The differential diagnosis for retiform purpura is broad, including vasculitides of the small and medium vessels as well as microvascular occlusion due to thrombotic, infectious, and embolic phenomena. Determining the etiology of this important dermatologic sign can be a diagnostic challenge; however, an organized approach can improve the speed and accuracy of diagnosis and identify an effective treatment. This review focuses on early recognition, evaluation, and treatment of hospitalized patients with retiform purpura. Specifically, vasculitis, protein C and S deficiencies, heparin necrosis, warfarin necrosis, antiphospholipid antibody syndrome, disseminated intravascular coagulation, cryoglobulinemia, calciphylaxis, and cholesterol embolization syndrome will be discussed in detail. These conditions are commonly seen in consultative dermatology and can have multiorgan involvement, complicated laboratory evaluation, and long-term therapeutic implications.

Original languageEnglish (US)
Pages (from-to)151-172
Number of pages22
JournalDermatologic Therapy
Issue number2
StatePublished - Mar 2011
Externally publishedYes


  • Antiphospholipid antibody syndrome
  • Hospitalized patient
  • Livedo reticularis
  • Retiform purpura
  • Skin necrosis
  • Thrombosis

ASJC Scopus subject areas

  • Dermatology


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