Effective Treatment of Senile Purpura

Senile purpura (also known as "Actinic purpura," and "Solar purpura") was first described by Bateman¹ in 1818 when he noted dark purple blotches and determined that they were due to the extravasation of blood into the dermal tissue. Patients with this condition develop persistent dark purple ecchymoses, which are characteristically confined to the extensor surfaces of the hands and forearms.² Unlike other ecchymoses, which evolve into brown patches, senile purpura tends to fade to fainter shades of purple, although residual brown pigmentation may persist for weeks to months, or may be permanent.^3,4 Although cosmetically displeasing, the disorder has no health consequences. Nevertheless, patients with senile purpura are often embarrassed by their purple blotches, and will tend to wear concealing clothing in an attempt to prevent exposure.

Causes
The purple ecchymoses and patches of this condition occur because red blood cells leak out of capillaries into the dermal tissue. This extravasation is secondary to the fragility of the blood vessel walls caused by chronic sun exposure with the resultant ultraviolet radiation, which induces dermal tissue atrophy. Because of the ultraviolet-induced atrophy, the connective tissue of the dermis is no longer able to adequately support the microvasculature. As a result, even minor trauma can tear the capillaries, leading to the extravasation of blood.⁵

Senile purpura may also be a sign of collagen loss in skin and bone. Women have less collagen than men and it decreases by one percent a year in exposed and unexposed skin. These changes in skin collagen may correspond to changes in bone density. It is hypothesized that changes in skin collagen also occur in bone collagen, leading to the associated changes in bone density.⁶

Epidemiology
In the United States, the occurrence of senile purpura is almost exclusively limited to the elderly population, commonly found in approximately 11.9 percent of those older than 50 years. Its prevalence markedly increases with years of exposure to the sun and is more pronounced in fair-skinned individuals than in others. Both sexes are equally affected.⁷

Conventional treatment
There is no conventional medicine for senile purpura.

Integrative treatment
Integrative treatment for senile purpura is effective, and may consist of using key nutraceuticals and one homeopathic remedy. Following is a discussion of these.

Vitamin C
Vitamin C is required for the synthesis of collagen, an important structural component of blood vessels, tendons, ligaments, and bone.⁸ Symptoms of scurvy, the classic vitamin C deficiency disease, include bleeding and bruising easily. These symptoms appear to be related to the weakening of blood vessels and connective tissue, both of which contain collagen.⁹ Consequently, maintaining healthy vitamin C status would appear to be an important consideration in the prevention of purpura. This was found to be the case in a double-blind, placebo-controlled trial¹⁰ of 94 elderly patients with initially low levels of vitamin C. After two months of vitamin C supplementation, clinical improvement was indicated by reductions in purpura and petechial hemorrhages (i.e., a small discrete capillary hemorrhage under the skin).

NOTE: Flavonoids help improve the absorption of vitamin C.^11,12 Consequently, any of the following flavonoids have value from that perspective. In addition, they offer other benefits as indicated.

Rutin
Rutin is a flavonoid, an antioxidant, a free radical scavenger, and an iron-chelator.13,14 In solar purpura, the value of an antioxidant is to help reduce potential oxidative damage from the sun's UV-rays.

Furthermore, rutin has been reported to decrease capillary fragility and permeability.¹⁵ In an 8-month trial,¹⁶ oral treatment with rutin significantly decreased (P<0.05) in capillary filtration. In other research,^17,18,19 treatment with rutin also significantly decreased capillary filtration.

Citrus bioflavonoids
Citrus bioflavonoids have antioxidant effects and include diosmin, eriodictyol, hesperidin, neohesperidoside, naringenin, eriocitrin, neodiosmin, rutinoside, chrysoeriol, isorhamnetin, limocitrin, limocitrol, isolimocitrol, and others.^20,21 In animal models of diabetes, a diet containing citrus flavonoids consisting of 0.2 percent eriocitrin and 0.2 percent hesperidin results in reduced measures of oxidative stress after 28 days of treatment.²²

Hesperidin
Hesperidin alone is frequently used for vascular conditions such as hemorrhoids and varicose veins since it helps improves venous tone, reduces stasis, restores normal capillary permeability, and improve lymphatic drainage. Hesperidin can also reduce the generation of free radicals.^23,24,25,26 A randomized, controlled, crossover study²⁷ also demonstrated that hesperidin provides vascular protective effects, including protective effects on the microvascular endothelium.

Eriocitrin
In animal research, the lemon flavonoid, eriocitrin was shown to be effective in the prevention of oxidative damage.²⁸ Similar research demonstrated an increase in plasma antioxidant activity increased following oral administration of eriocitrin.²⁹ Additional research has also shown eriocitrin's antioxidant activity.³⁰

Arnica montana
The homeopathic remedy Arnica montana is commonly used to treat bruising. In a randomized, double-blind, placebo-controlled clinical trial,³¹ A. montana was used on 29 face-lift patients to assess efficacy in reducing bruising. The results were that patients treated with A. montana were found to have a smaller area of ecchymosis on postoperative days 1, 5, 7, and 10, with these differences reaching statistical significance on postoperative days 1 and 7.

A. montana's effectiveness in reducing bruising may be related to its ability to reduce bleeding. In another double blind, placebo-controlled, randomized, clinical trial,³² treatment with A. montana and Bellis perennis was found to reduce postpartum blood loss, as compared with placebo.

Combining rutin with vitamin C
In an open pilot study,³³ oral rutin and vitamin C were administered to three patients with chronic progressive pigmented purpura (PPP), a different type of purpura. At the end of the 4-week treatment period, complete clearance of the skin lesions was achieved in all three patients. No adverse reactions were noted. All patients remained free of lesions at the end of 3-months treatment. A case report³⁴ on another patient with PPP showed similar benefits when supplemented with rutin and vitamin C.

Combining vitamin C, rutin, citrus bioflavonoids, hesperidin, eriocitrin and A. montana
A six-week, randomized, multicenter, placebo-controlled, double-blind study³⁵ was undertaken to evaluate the efficacy of a dietary supplement combining vitamin C, rutin, citrus bioflavonoids, hesperidin, eriocitrin and A. montana in the treatment of senile purpura. Seventy patients with senile purpura were enrolled and 67 completed the study. Subjects were randomized into two groups receiving either a supplement blend or placebo medication, which was taken orally twice daily for six weeks.

The results were a statistically significant reduction in the number of new purpura lesions in the skin area undergoing clinical study. At the end of six weeks, the supplement blend treated group showed a 50 percent reduction in purpura lesions from baseline. Patient self-assessment of the effectiveness of the medication echoed the results of an investigator global assessment with a statistically significant improvement in the skin's appearance noted by the patients receiving the supplement. No adverse effects were noted by either the patients or investigators. The authors of this study concluded that the supplement blend appears to both safely and effectively diminish skin bruising in patients with senile purpura.

Conclusion
Patients with senile purpura are often embarrassed by their purple blotches. Integrative treatment with vitamin C, key flavonids and the homeopathic A. montana has been show to result in a 50 percent reduction in skin purpura lesions.

References

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Senile Purpura Actinic purpura Solar purpura