Senile Purpura

Senile Purpura Definition

Senile purpura is a common condition in elderly people who are prone to develop bruises especially on their forearms and legs. In old age, skin becomes thinner and fragile. Bruises incline to form as blood vessels in the skin are also found fragile in old age.

At initial stages, bruises are seen purplish red. These bruises do not develop due to vitamins and minerals deficiencies or because of other bleeding disorders [1]. Senile purpura is also called purpura senilis, skin hemorrhages or blood spots.

Senile purpura usually presents with spots or patches present on skin, mucous membrane as well as on the organs. When blood leaks under the skin or from where small blood vessels joins together; this condition is called purpura. These hemorrhagic spots can be of different sizes.

Very small spots of purpura are called petechiae and large purpura is called ecchymoses2.


  • Aging or some other conditions like, ultraviolet (UV) radiation damage due to too much sun exposure may weaken the connective tissues that hold the blood vessels in the matrix. In other words, connective tissues get weaken and skin becomes thinner naturally in the old age.
  • Other causes of senile purpura include overuse of blood thinners like steroids and aspirin. Vascular diseases and diabetes may also lead to develop senile purpura.
  • However, it should be differentiated from thrombocytopenia (low platelet count), connective tissue diseases and scurvy (vitamin C deficiency) [3].
  • Causes of non-thrombocytopenic purpura include blood clotting disorders, drugs that affect the platelet function, fragile blood vessels, amyloidosis (disorder that causes the deposition of amyloid protein deposition in the tissues), congenital cytomegalovirus, hemangioma, inflammation of blood vessels, steroid use, pressure changes occurring during vaginal delivery and vitamin C deficiency (scurvy).
  • Thrombocytopenic purpura occurs due to certain infections like meningococcemia, idiopathic thrombocytopenic purpura and the drugs that prevent platelet formation or disturb their function3.

Symptoms of Senile Purpura

Found in the elderly people who suffer from recurrent bleeding only in the skin and more in the exposed parts. It is not associated with any exogenous history. Symptoms of senile purpura include the following symptoms:

  • Spots found on the neck, back of the hands and the extensor surfaces of upper limbs.
  • Spots and patches purple in color found in the skin
  • The patches leave a yellow or brown stain
  • Occurs as chronic relapsing condition
  • Thin skin
  • Skin lacks elasticity
  • Skin tears easily
  • Patches occur without trauma or injury
  • Purple or red purpuric and ecchymotic patches.
  • Visceral purpura is rare
  • Bruises fade away within a few days but discoloration due to iron deposition at the trauma site lasts for long duration.


For differential diagnosis following investigations are necessary:

  • Complete blood count (CBC) with differential count
  • Coagulation profile (PT, aPTT with INR)
  • Examination of urine to rule out blood in urine such as reported in Henosh-Schonlein purpura (HSP)
  • Liver function tests (LFTs) to rule out hepatitis (inflammation of liver)
  • Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) to evaluate inflammation in the collage vascular diseases
  • Renal function tests (RFTs) to evaluate renal status in the polyarteritis nodosa, SLE, Henosh-Schonlein purpura, and many other diseases causing purpura
  • Skin and blood cultures by punch biopsy if patient is febrile
  • Rheumatoid factor (RF), antinuclear antibodies (ANA) and viral hepatitis serology
    Cancer screening

Differential Diagnosis of Senile Purpura

Differential diagnosis is based upon palpable and non-palpable purpura [4]:

Palpable purpura

Collagen Vascular diseases

  • Rheumatoid arthritis
  • Systemic lupus erythematosus (SLE)
  • Sjogren’s syndrome

Internal Malignancies

  • Lymphoma
  • Multiple Myeloma
  • Leukemia

Leukocytoclastic Vasculitis

  • Vasculitic injury to the liver, brain, kidneys, lungs and GI tract
  • Necrotizing vasculitis of small vessels
  • Purpura motivating factors like drugs, blood abnormalities and infections

Other Vasculitis disorders

  • Polyarteritis nodosa
  • Henoch-Schonlein syndrome
  • Granulomatous vasculitis


  • Heparin
  • Warfarin
  • NSAIDs
  • Aspirin

Non-palpable Purpura


  • Disseminated intravascular coagulation
  • Thrombocytopenic purpura
  • Drug induced thrombocytopenia
  • Idiopathic thrombocytopenic purpura
  • Bacteremia and viral diseases


  • Scurvy
  • Chronic stasis
  • Trauma
  • TORCH infection
  • Systemic diseases
  • Advancing age
  • Anticoagulant therapy
  • Actinic changes

Senile Purpura Images

Picture 1 : Senile Purpura on lower legs
Image source :

Picture 2 :Senile Purpura Photo
Image source :


Laboratory tests

  • Normal platelet count
  • Positive capillary fragility test
  • Normal hemostasis

Diagnostic criteria

  • Common in older age more than 60 years, both in male and female
  • Normal platelet count
  • Purpura of skin about 1 to 4 cm in diameter, mainly on the exposed parts, such as hands, legs, neck, face and under the arms.
  • Positive beam arm test
  • Affected skin atrophy
  • Normal hemostasis


Senile purpura is considered harmless. However, it cannot be cured with conventional methods. Bruises fade with the passage of time. It occurs with the increasing age. Long term avoidance of sun exposure may help with it. Supplementation with vitamin C, flavonoids and other antioxidants helps protecting the skin. Skin moiturization prevents easy bruising.



Published on by under Skin and Hair.
Article was last reviewed on September 11th, 2016.

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