Advertisement

Stains

  • Roberta Castilhos da Silva
  • Mariele Bevilaqua
  • Jenifer de Morais Silva
Chapter

Abstract

The term “stain” is used to describe an elementary dermatologic lesion flat and not palpable, of changing color. This chapter approaches the main disturbances that manifest as stains on the skin surface, which are divided into three major groups: hyperchromia, hypochromia, and vascular injury. These conditions can be hereditary or acquired from several factors, such as infectious, inflammatory, and external agents (chemical and physical substances and some drugs). The diseases that present themselves with stains are frequently found in primary clinical service. Often the correct differential diagnoses in their etiology will prevent further damage. Therefore, through a practical guide using flowcharts based on descriptive text, this chapter is intended to help the reader in the greater understanding of each involved disease. It is important to make the diagnostic conclusion easier and to take the most appropriate action to treat the patient. Moreover, this chapter should help the general physician to identify the correct criteria for referral of the patient to a dermatologist whenever a specific intervention is necessary.

Keywords

Stains Pigmentary changes Achromic stain Hypochromic stain Hyperchromic stain Purpura Vascular stain Diagnostic algorithms Public health 

Notes

Glossary

Cryotherapy

A technique that uses an extremely cold liquid or instruments to freeze and destroy abnormal skin cells that require removal. It can be used to destroy a variety of benign skin growths, such as warts, actinic keratoses, and some malignant lesions (such as superficial basal cell and squamous cell cancers).

Cutis verticis gyrata

A condition of the skin of the forehead with hypertrophy and deep vertical folds so as to resemble the surface of the brain. It is a feature of acromegaly, local inflammation, and acute myeloid leukemia. A rare primary form, which affects males only, is associated with neurologic problems.

Darier’s sign

Skin change produced when the skin lesion in urticaria pigmentosa is rubbed briskly. The area usually begins to itch and becomes raised and surrounded by erythema.

Dermabrasion

A technique whereby a dermatome or abrading device is used to remove the epidermis and superficial dermis, allowing regeneration of the epithelium to occur from underlying adnexal structure.

Excimer laser

A powerful form of laser which is nearly always operated in the ultraviolet spectral region and generates nanosecond pulses.

Furocoumarins

A class of organic chemical compounds produced by a variety of plants. They sensitize the skin to the effects of the sun, thus leading to irregular pigmentation and increasing the risk of sunburn and phototoxicity.

Koebner’s phenomenon (isomorphic response)

The appearance of new skin lesions on areas of cutaneous injury in otherwise healthy skin, with the same clinical and histologic features as lesions of the patient’s original skin disease.

Phototherapy

A technique used for the treatment of some skin diseases by exposure to light, including ultraviolet and infrared radiation. It is defined as either medium-wave light energy (ultraviolet-B light [UVB]) or long-wave light (ultraviolet-A [UVA]). UVB is available as narrowband or broadband.

Wood’s lamp

Created by Robert Williams Wood, this lamp used especially to detect some skin conditions by the fluorescence induced in the affected areas by ultraviolet radiation.

Zireli’s sign

Scaling of macules made prominent by stretching the affected skin. It is present in pityriasis versicolor.

References

  1. 1.
    Barsh GS. What controls variation in human skin color? PLoS Biol. 2003;1:19–22.CrossRefGoogle Scholar
  2. 2.
    Nordlund JJ, Boissy RE, Hearing VJ, King R, Oetting W, Ortonne JP. The pigmentary system: physiology and pathophysiology. 2nd ed. Oxford: Wiley-Blackwell; 2006.CrossRefGoogle Scholar
  3. 3.
    Fistarol SK, Itin PH. Disorders of pigmentation. JDDG. 2010;8:187–202.PubMedCrossRefGoogle Scholar
  4. 4.
    Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick Tratado de Dermatologia. 7a edição, Rio de Janeiro: Revinter; 2010.Google Scholar
  5. 5.
    Azulay RD, Azulay DR, Abulafia LA. Azulay Dermatologia. 6th ed. Rio de Janeiro: Guanabara Koogan; 2015.Google Scholar
  6. 6.
    Rübsam ML, Esch M, Baum E, Bösner S. Diagnosing skin disease in primary care: a qualitative study of GP’s. Fam Pract. 2015;32(5):591–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Kerr OA, Tidman MJ, Walker JJ, Aldridge RD, Benton EC. The profile of dermatologic problems in primary care. Clin Exp Dermatol. 2010;35(4):380–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Sociedade Brasileira De Dermatologia. Perfil nosológico das consultas dermatológicas no Brasil. An Bras Dermatol. 2006;81(6):549–58.CrossRefGoogle Scholar
  9. 9.
    Lupi O, Cunha PR. Rotinas de Diagnóstico e Tratamento da Sociedade Brasileira de Dermatologia. 2nd ed. Itapevi: AC Farmacêutica; 2012.Google Scholar
  10. 10.
    Majumder PP, Nordlund JJ, Nath SK. Pattern of familial aggregation of vitiligo. Arch Dermatol. 1993;129:994.PubMedCrossRefGoogle Scholar
  11. 11.
    Handa S, Kaur I. Vitiligo: clinical findings in 1436 patients. J Dermatol. 1999;26:653.PubMedCrossRefGoogle Scholar
  12. 12.
    Rivitti E. Manual de dermatologia clínica de Sampaio e Rivitti. São Paulo: Artes Médicas; 2014.Google Scholar
  13. 13.
    Jin Y, Birlea SA, Fain PR, Gowan K, Sheri L, Riccardi BS, et al. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med. 2010;362(18):1686–97.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Taïeb A, Picardo M. Vitiligo. N Engl J Med. 2009;360:160–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Taïeb A, Alomar A, Böhm M, Dell’Anna ML, Pase De A, Eleftheriadou V, et al. Guidelines for the management of vitiligo: the European Forum consensus. Br J Dermatol. 2013;168:5–19.PubMedCrossRefGoogle Scholar
  16. 16.
    Grimes PE. New insights and new therapies in vitiligo. JAMA. 2005;293:730.PubMedCrossRefGoogle Scholar
  17. 17.
    Falabella R, Escobar C, Giraldo N, Rovetto P, Gil J, Barona MI, et al. On the pathogenesis of idiopathic guttate hypomelanosis. J Am Acad Dermatol. 1987;16(1):1.CrossRefGoogle Scholar
  18. 18.
    Bolognia JL, Jorizzo JL, Schaffer JV; Kalil CLPV (organization); Corrêa ADC (translation), et al. Dermatologia. 3rd ed. Rio de Janeiro: Elsevier; 2015.Google Scholar
  19. 19.
    Kakepis M, Havaki S, Katoulis A, Katsambas A, Stavrianeas N, Troupis TG. Idiopathic guttate hypomelanosis: an electron microscopy study. JEADV. 2015;29:1435–8.PubMedGoogle Scholar
  20. 20.
    Kaya TI, Yazici AC, Tursen U, Ikizoglu G. Idiopathic guttate hypomelanosis: idiopathic or ultraviolet induced? Photodermatol Photoimmunol Photomed. 2005;21:270–1.PubMedCrossRefGoogle Scholar
  21. 21.
    Shin MK, Jeong KH, Oh IH, Choe BK, Lee MH. Clinical features of idiopathic guttate hypomelanosis in 646 subjects and association with other aspects of photoaging. Int J Dermatol. 2011;50:798–805.PubMedCrossRefGoogle Scholar
  22. 22.
    Friedland R, David M, Feinmesser M, Fenig-Nakar S, Hodak E. Idiopathic guttate hypomelanosis-like lesions in patients with mycosis fungoides: a new adverse effect of phototherapy. JEADV. 2010;24:1026–30.PubMedGoogle Scholar
  23. 23.
    Rerknimitr P, Disphanurat W, Achariyakul M. Topical tacrolimus significantly promotes repigmentation in idiopathic guttate hypomelanosis: a double-blind, randomized, placebo-controlled study. JEADV. 2013;27:460–4.PubMedGoogle Scholar
  24. 24.
    Tey HL. Approach to hypopigmentation disorders in adults. Clin Exp Dermatol. 2009;35:829–34.CrossRefGoogle Scholar
  25. 25.
    Ayres EL, Magrin PF, Bentivoglio F, Costa A. Progressive macular hypomelanosis: an epidemiological study of 103 cases in Southeast Brazil. Surg Cosmet Dermatol. 2015;7(1):56–60.Google Scholar
  26. 26.
    Hwang SW, Hong SK, Kim SH, Hoon Park JH, Seo JK, Sung HS, et al. Progressive macular hypomelanosis in Korean patients: a clinicopathologic study. Ann Dermatol. 2009;21(3):261–7.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Almeida ART, Bedani TP, Debs EAF, Ferreira JAD. Estudo piloto para avaliar a eficácia da minociclina no tratamento da hipomelanose macular progressiva (HMP). Surg Cosmet Dermatol. 2009;1(1):25–8.Google Scholar
  28. 28.
    Relyveld GN, Menke HE, Westerhof W. Progressive macular hypomelanosis: an overview. Am J Clin Dermatol. 2007;8(1):13–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Rodríguez-Lojo R, Verea MM, Velasco D, Barjaa JM. Hipomelanosis macular progresiva y confluente. Actas Dermosifiliogr. 2010;101(3):268–83.PubMedCrossRefGoogle Scholar
  30. 30.
    Tey HL. A practical classification of childhood hypopigmentation disorders. Acta Derm Venereol. 2010;90:6–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Cavalcanti SMM, Magalhães V, Magalhães M, Querino MCD, França ERD, Alencar E. Uso da limeciclina associada com o peróxido de benzoíla no tratamento da hipomelanose macular progressiva: um estudo prospectivo. An Bras Dermatol. 2011;86(4):813–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Duarte I, Della Nina BI, Gordiano MC, Buense R, Lazzarini R. Hipomelanose macular progressiva: estudo epidemiológico e resposta terapêutica à fototerapia. An Bras Dermatol. 2010;85(5):621–4.PubMedCrossRefGoogle Scholar
  33. 33.
    In SI, YI SW, Kang HY, Lee ES, Sohn S, Kim YC. Clinical and histopathologic characteristics of pityriasis alba. Clin Exp Dermatol. 2008;34:591–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Malik TG, Khalil M, Bhatti MM. Pityriasis alba with poliosis. J Coll Phys Surg Pak. 2014;24(2):138–40.Google Scholar
  35. 35.
    Weber MB, Ávila LGS, Albaneze R, Oliveira OLM, Sudhaus BD, Cestari TF. Pityriasis alba: a study of pathogenic factors. JEADV. 2002;16:463–8.Google Scholar
  36. 36.
    Cruz BM, Cázares JPC, Álvarez BT, Gonzáles BM. Pitiriasis alba. Dermatol Rev Mex. 2010;54(2):67–71.Google Scholar
  37. 37.
    Du Toit MJ, Jordaan HF. Pigmenting pityriasis alba. Pediatr Dermatol. 1993;10(1):1–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Sandhu K, Handa S, Kanwar J. Extensive pityriasis alba in a child with atopic dermatitis. Pediatr Dermatol. 2004;21(3):275–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Pla VF, Aznar CPS. Esclerodermia. Med Clin (Barc). 2004;122(11):418–9.CrossRefGoogle Scholar
  40. 40.
    Nieves AT, Holguera RM, Atrio AS. Esclerodermia. Medicine. 2013;11(32):1981–90.Google Scholar
  41. 41.
    Zancanaro PCQ, Garcia LT, Isaac AR, Costa IMC. Esclerodermia localizada na criança: aspectos clínicos, diagnósticos e terapêuticos. An Bras Dermatol. 2009;84(2):161–72.PubMedCrossRefGoogle Scholar
  42. 42.
    Macedo PA, Shinjo SK, Goldenstein-Schainberg C. Esclerodermia juvenil. Acta Reumatol Port. 2008;33:289–97.PubMedGoogle Scholar
  43. 43.
    Garza-Rodríguez V, Villarreal-Alarcón MA, Ocampo-Candiani J. Etiopatogenia y tratamiento de la esclerodermia: conceptos actuales. Rev Med Inst Mex Seguro Soc. 2013;51(5):50–7.PubMedGoogle Scholar
  44. 44.
    Bossini-Castillo L, Martín JE, Días-Gallo LM, Rueda B, Javier M. Genética de la esclerodermia. Reumatol Clin. 2010;6(S2):12–5.PubMedCrossRefGoogle Scholar
  45. 45.
    McPherson T, Cooper S. Vulval lichen sclerosus and lichen planus. Dermatol Ther. 2010;23:523.PubMedCrossRefGoogle Scholar
  46. 46.
    Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353:1777.PubMedCrossRefGoogle Scholar
  47. 47.
    Higgins CA, Cruickshank ME. A population-based case-control study of etiological factors associated with vulval lichen sclerosus. J Obstet Gynaecol. 2012;32:271.PubMedCrossRefGoogle Scholar
  48. 48.
    Neill SM, Lewis FM, Tatnall FM, Cox NH. British Association of Dermatologists’ guidelines for the management of lichen sclerosus. Br J Dermatol. 2010;163:672.PubMedCrossRefGoogle Scholar
  49. 49.
    Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations. Clin Dermatol. 2006;24:348.PubMedCrossRefGoogle Scholar
  50. 50.
    Kuhn A, Sonntag M, Richter-Hintz D, et al. Phototesting in lupus erythematosus: a 15-year experience. J Am Acad Dermatol. 2001;45:86.PubMedCrossRefGoogle Scholar
  51. 51.
    Kuhn A, Ruland V, Bonsmann G. Photosensitivity, phototesting, and photoprotection in cutaneous lupus erythematosus. Lupus. 2010;19:1036.PubMedCrossRefGoogle Scholar
  52. 52.
    Kuhn A, Gensch K, Haust M, et al. Photoprotective effects of a broad-spectrum sunscreen in ultraviolet-induced cutaneous lupus erythematosus: a randomized, vehicle-controlled, double-blind study. J Am Acad Dermatol. 2011;64:37.PubMedCrossRefGoogle Scholar
  53. 53.
    Wahie S, Daly AK, Cordell HJ, et al. Clinical and pharmacogenetic influences on response to hydroxychloroquine in discoid lupus erythematosus: a retrospective cohort study. J Invest Dermatol. 2011;131:1981.PubMedCrossRefGoogle Scholar
  54. 54.
    Boyle J, Kennedy CTC. Leucoderma induced by monomethyl ether of hydroquinone. Clin Exp Dermatol. 1985;10:154–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Williams H. Skin lightening creams containing hydroquinone. Br J Dermatol. 1992;305:903–4.Google Scholar
  56. 56.
    Ghosh S, Mukhopadhyay S. Chemical leucoderma: a clinicoetiological study of 864 cases in the perspective of a developing country. Br J Dermatol. 2009;160:40–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Petit A. Prise en charge des complications de la dépigmentation volontaire en France. Ann Dermatol Venereol. 2006;133:907–16.PubMedCrossRefGoogle Scholar
  58. 58.
    Fernández-Vozmediano JM, Armario-Hita JC. Etiopatogenia y tratamiento de la pitiriasis versicolor. Med Clin (Barc). 2006;126(1):7–13.CrossRefGoogle Scholar
  59. 59.
    Schwartz RA. Superficial fungal infections. Lancet. 2004;364:1173.PubMedCrossRefGoogle Scholar
  60. 60.
    Centeno LBZ, Pacheco AML, Murillo EE, Huerta EA, Calvo AMG. Pitiriasis versicolor. SEMERGEN. 2001;27:48–50.CrossRefGoogle Scholar
  61. 61.
    Hu SW, Bigby M. Pityriasis versicolor: a systematic review of interventions. Arch Dermatol. 2010;146:1132.PubMedCrossRefGoogle Scholar
  62. 62.
    Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: pityriasis (tinea) versicolor. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol. 1996;34:287.PubMedCrossRefGoogle Scholar
  63. 63.
    Britton WJ, Lockwood DNJ. Leprosy. Lancet. 2004;363(10):1209–19.PubMedCrossRefGoogle Scholar
  64. 64.
    Ministério da Saúde do Brasil. Guia para o Controle da Hanseníase. 3rd ed. Brasília: Ministério da Saúde, 2002.Google Scholar
  65. 65.
    Ministério da Saúde do Brasil. Protocolo de Atendimento em Hanseníase. 1st ed. Brasília; Subsecretaria de Vigilância à Saúde, 2007.Google Scholar
  66. 66.
    Faye O, Hay RJ, Ryan TJ, Keita S, Traore AK, Mahe A. A public health approach for leprosy detection based on a very short term-training of primary health care workers in basic dermatology. Lepr Ver. 2007;78:11–6.Google Scholar
  67. 67.
    Walker SL, Lockwood DNJ. Leprosy. Clin Dermatol. 2007;25:165–72.PubMedCrossRefGoogle Scholar
  68. 68.
    Ustianowski AP, Lockwood DNJ. Leprosy: current diagnostic and treatment approaches. Curr Opin Infect Dis. 2003;16:421–7.PubMedCrossRefGoogle Scholar
  69. 69.
    Moschella SL. An update on the diagnosis and treatment of leprosy. J Am Acad Dermatol. 2004;51:417–26.PubMedCrossRefGoogle Scholar
  70. 70.
    Peterman TA, Kahn RH, Ciesielski CA, et al. Misclassification of the stages of syphilis: implications for surveillance. Sex Transm Dis. 2005;32:144.PubMedCrossRefGoogle Scholar
  71. 71.
    Patton ME, Su JR, Nelson R, et al. Primary and secondary syphilis – United States, 2005–2013. MMWR Morb Mortal Wkly Rep. 2014;63:402.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Calonge N, U.S. Preventive Services Task Force. Screening for syphilis infection: recommendation statement. Ann Fam Med. 2004;2:362.PubMedCrossRefGoogle Scholar
  73. 73.
    Hook EW, Peeling RW. Syphilis control – a continuing challenge. N Engl J Med. 2004;351:122.PubMedCrossRefGoogle Scholar
  74. 74.
    Douglas JM Jr. Penicillin treatment of syphilis: clearing away the shadow on the land. JAMA. 2009;301:769.PubMedCrossRefGoogle Scholar
  75. 75.
    Summers CG. Albinism: classification, clinical characteristics, and recent findings. Optom Vis Sci. 2009;86:659.PubMedCrossRefGoogle Scholar
  76. 76.
    Hartmann A, Brocker EB, Becker JC. Hypopigmentary skin disorders: current treatment options and future directions. Drugs. 2004;64(1):89.PubMedCrossRefGoogle Scholar
  77. 77.
    Crino PB, Nathanson KL, Henske EP. The tuberous sclerosis complex. N Engl J Med. 2006;355:1345.PubMedCrossRefGoogle Scholar
  78. 78.
    Curatolo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet. 2008;372:657.PubMedCrossRefGoogle Scholar
  79. 79.
    Schwartz RA, Fernández G, Kotulska K, Józwiak S. Tuberous sclerosis complex: advances in diagnosis, genetics, and management. J Am Acad Dermatol. 2007;57:189.PubMedCrossRefGoogle Scholar
  80. 80.
    Kwiatkowski DJ, Manning BD. Molecular basis of giant cells in tuberous sclerosis complex. N Engl J Med. 2014;371:778.PubMedCrossRefGoogle Scholar
  81. 81.
    Bolognia JL, Lazova R, Watsky K. The development of lentigines within segmental achromic nevi. J Am Acad Dermatol. 1998;39:330–3.PubMedCrossRefGoogle Scholar
  82. 82.
    Hewedy ESS, Hassan AM, Salah EF, Sallam FA, Dawood NM, Al-Bakary RH, Al-Sharnoby HA. Clinical and ultrastructural study of nevus depigmentosus. J Microsc Ultrastruct. 2013;1:22–9.CrossRefGoogle Scholar
  83. 83.
    Lee HS, Chun YS, Hann SK. Nevus depigmentosus: clinical features and histopathologic characteristics in 67 patients. J Am Acad Dermatol. 1999;40:21–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Kim SK, Kang HY, Lee ES, Kim C. Clinical and histopathologic characteristics of nevus depigmentosus. J Am Acad Dermatol. 2006;55:423–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Sanjeev M, Ahmed AI, Abdullah AE. Nevus depigmentosus treated by melanocyte-keratinocyte transplantation. J Cutan Aesth Surg. 2011;4(1):29.CrossRefGoogle Scholar
  86. 86.
    Shim JH, Seo SJ, Song KY, Hong CK. Development of multiple pigmented nevi within segmental nevus depigmentosus. J Korean Med Sci. 2002;17:133–6.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Cestari TF, Dantas LP, Boza JC. Acquired hyperpigmentations. An Bras Dermatol. 2014;89(1):11–25.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Pathak MA. Phytophotodermatitis. Clin Dermatol. 1986;4(2):102–21.PubMedCrossRefGoogle Scholar
  89. 89.
    Weber IC, Davis CP, Greeson DM. Phytophotodermatitis: the other “lime” disease. J Emerg Med. 1999;17(2):235–7.PubMedCrossRefGoogle Scholar
  90. 90.
    Katoulis AC, Stavrianeas NG, Katsarou A, Antoniou C, Georgala S, Rigopoulos D, Koumantaki E, Avgerinou G, Katsambas AD. Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte. Br J Dermatol. 2002;147:493–7.PubMedCrossRefGoogle Scholar
  91. 91.
    Katoulis AC, Stavrianeas NG, Georgala S, Katsarou-Katsari A, Koumantaki-Mathioudaki E, Antoniou C, Stratigos JD. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol. 1999;24:385–7.PubMedCrossRefGoogle Scholar
  92. 92.
    Nofal A, Salah E. Acquired poikiloderma: proposed classification and diagnostic approach. J Am Acad Dermatol. 2013;69:el29–140.CrossRefGoogle Scholar
  93. 93.
    Dummer R, Graf P, Grief C, Burg G. Treatment of vascular lesions using the versapulse variable pulse width frequency doubled neodymium:YAG laser. Dermatology. 1998;197:158–61.PubMedCrossRefGoogle Scholar
  94. 94.
    Adrian RM. Treatment of leg telangiectasias using a long-pulse frequency-doubled neodymium:YAG laser at 532 nm. Dermatol Surg. 1998;24:19–23.PubMedGoogle Scholar
  95. 95.
    Addison T. On the constitutional and local effects of diseases of the supra-renal capsules. London: Warren and Son; 1855.Google Scholar
  96. 96.
    Nieman LK, Chanco Turner ML. Addison’s disease. Clin Dermatol. 2006;24:276–80.PubMedCrossRefGoogle Scholar
  97. 97.
    Alto WA, Clarcq L. Cutaneous and systemic manifestations of mastocytosis. Am Fam Physician. 1999;59(11):3047–54.PubMedGoogle Scholar
  98. 98.
    Buszman E, Betlej B, Wrześniok D, Radwańska-Wala B. Effect of metal ions on melanin–local anaesthetic drug complexes. Bioinorg Chem Appl. 2003;1(2):113–22.PubMedCentralCrossRefGoogle Scholar
  99. 99.
    Martins VM, Sousa AR, Portela Nde C, Tigre CA, Gonçalves LM, Castro Filho RJ. Exogenous ochronosis: case report and literature review. An Bras Dermatol. 2012;87(4):633–6.PubMedCrossRefGoogle Scholar
  100. 100.
    Kayal L, Jayachandran S, Singh K. Idiopathic thrombocytopenic purpura. Contemp Clin Dent. 2014;5(3):410–4.PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick Tratado de Dermatologia. 7th ed. Rio de Janeiro: Revinter; 2010.Google Scholar
  102. 102.
    Chalmers E, Cooper P, Forman K, Grimley C, Khair K, Minford A, Morgan M, Mumford AD. Purpura fulminans: recognition, diagnosis and management. Arch Dis Child. 2011;96(11):1066–71.PubMedCrossRefGoogle Scholar
  103. 103.
    Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet. 2002;360:1197–202.PubMedCrossRefGoogle Scholar
  104. 104.
    Gonzalez-Gay MA, Calvino MC, Vazquez-Lopez ME, Garcia-Porrua C, Fernandez-Iglesias JL, Dierssen T, et al. Implications of upper respiratory tract infections and drugs in the clinical spectrum of Henoch-Schönlein purpura in children. Clin Exp Rheumatol. 2004;22:781–4.PubMedGoogle Scholar
  105. 105.
    Saulsbury FT. Henoch-Schönlein purpura. Curr Opin Rheumatol. 2001;13:35–40.PubMedCrossRefGoogle Scholar
  106. 106.
    Magro CM, Schaefer JT, Crowson AN, Li J, Morrison C. Pigmented purpuric dermatosis: classification by phenotypic and molecular profiles. Am J Clin Pathol. 2007;128:218–29.PubMedCrossRefGoogle Scholar
  107. 107.
    Cho JH, Lee JD, Kang H, Cho SH. The clinical manifestations and etiologic factors of patients with pigmented purpuric dermatoses. Korean J Dermatol. 2005;43:45–52.Google Scholar
  108. 108.
    Dai HK, Soo HS, Hyo HA, Young CK, Jae EC. Characteristics and clinical manifestations of pigmented purpuric dermatosis. Ann Dermatol. 2015;27(4):404–10.CrossRefGoogle Scholar
  109. 109.
    Steven BP, Peter MM. Raynaud phenomenon. JHS. 2013;38(A):375–8.Google Scholar
  110. 110.
    Ratchford EV, Evans NS. Raynaud’s phenomenon. Vasc Med. 2015;20(3):269–71.PubMedCrossRefGoogle Scholar
  111. 111.
    Criado PR, Faillace C, Magalhães LS, Brito K, Carvalho JF. Livedo reticular: classificação, causas e diagnósticos diferenciais. Acta Reumatol Port. 2012;37:218–25.PubMedGoogle Scholar
  112. 112.
    Gibbs MB, English JC 3rd, Zirwas MJ. Livedo reticularis: an update. J Am Acad Dermatol. 2005;52(6):1009–19.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Roberta Castilhos da Silva
    • 1
  • Mariele Bevilaqua
    • 2
  • Jenifer de Morais Silva
    • 1
  1. 1.Dermatology, University of Caxias do Sul, School of MedicineCaxias do SulBrazil
  2. 2.Dermatology Service of Federal University of Health Sciences of Porto Alegre,Porto AlegreBrazil

Personalised recommendations