1. Characteristics of Purpura
Discoloration of the skin that does not blanch when touched is called purpura. This is a specific condition related to the immune system wherein red blood cells do not function in the body as they should. It is also an indication of low platelet count in the body. Purpura can come in a variety of colors, the same colors seen in bruises: purple, red, brown, green and yellow. Purpura is classified into three distinct categories: palpable purpura, non-palpable purpura and capillaritis of unknown cause. "Palpable" merely indicates that the purpura can be felt beneath the skin as well as seen. Purpura is either acute or chronic. Acute purpura is mostly present in children and resolves itself within six months. Chronic purpura lasts longer than six months and is most often seen in adults.
2. Initial Treatment
Purpura is basically an inflammation. It is first treated with prednisone, a powerful anti-inflammatory. It is not ideal for anyone to be on prednisone for a significant length of time. Prednisone is caustic to the liver and kidneys and usually causes significant weight gain. The most common side effect is known colloquially as "moon face," in which the face becomes fuller and rounder due to weight gain. If purpura responds to prednisone therapy, an afflicted person can usually be tapered off from the prednisone.
3. Secondary Treatment
If the recommended dose of prednisone does not affect the purpura, there are two courses of action your doctor may take. He will either up the dose of prednisone or give intravenous immunoglobulin. The immunoglobulin fights purpura by helping to boost platelet counts within the body. Immunoglobulin is not considered a good first line of defense because it is significantly more expensive to administer, yet it does not yield results that are statistically better than increasing the prednisone. It is simply a matter of different body chemistry responding to different treatments.
4. Splenectomy as a Treatment for Purpura
Since purpura is essentially the body attacking itself when it perceives an enemy within its bounds, doctors sometimes remove the spleen in adult patients. The spleen is one of the most important components of the immune system; it assists the lymph nodes in filtering contaminants from the body. The literature offers differing statistics, but anywhere from 20 to 70 percent of patients recover from their splenectomies and experience no further difficulties with purpura.
5. When Splenectomy Fails
In some patients, splenectomy simply is not the answer. At this point, it is likely that a liver/spleen scan will be done to see if there is an accessory spleen that has grown in the body and interfered with the immune system. Removal of this spleen can produce results in eliminating the purpura. If there is no accessory spleen, doctor and patient must evaluate the pros and cons of remaining on a low dose of predisone or immunoglobulin. Sometimes, increased platelets are not enough of a risk to justify continued exposure to caustic medications.
