Purpura refers to purple or red spots that appear on the skin. It happens when small blood vessels leak blood under the skin. Purpura spots are generally harmless and disappear on their own in a few days or weeks. However, purpura can sometimes indicate a more serious medical condition, especially if the spots are larger or more numerous. Determining the cause of purpura can help guide treatment. One potential cause of purpura is vitamin deficiency.
What is purpura?
Purpura occurs when small blood vessels burst and leak blood into the skin. This causes purple or red spots that range in size from pinpoints to larger blotches. The spots may look like bruises but are not caused by injury.
There are several different types of purpura:
– Petechiae – Tiny purpura spots that are pinpoint-sized. Petechiae usually appear in clusters.
– Ecchymosis – Larger purpura spots that can be several centimeters wide.
– Senile purpura – Occurs in older adults, often on the forearms and hands. Caused by fragile blood vessels.
– Idiopathic thrombocytopenic purpura (ITP) – Caused by low platelet counts. Leads to extensive brusing and larger purpura.
Purpura occurs when the integrity of small blood vessels is compromised. This allows blood to seep into the skin. Purpura is often benign, especially when the spots are small and limited in number. However, some medical conditions can cause excessive or worsening purpura that requires treatment.
What causes purpura?
Some common causes of non-symptomatic purpura include:
– Age – Older adults develop senile purpura more readily due to fragile blood vessels.
– Medications – Blood thinners and corticosteroids may lead to purpura.
– Sun exposure – UV rays can damage blood vessels.
– Physical trauma – Any impact or injury to the skin can cause blood vessels to leak.
More serious causes of symptomatic or excessive purpura include:
Vitamin C deficiency
Not having enough vitamin C (ascorbic acid) can cause blood vessels to become fragile and prone to bleeding under the skin. This leads to purpura and bruising.
Vitamin K deficiency
Vitamin K is essential for proper blood clotting. Without enough vitamin K, blood has trouble clotting after a blood vessel injury. This allows bleeding under the skin to form purpura spots.
Blood disorders
Conditions like leukemia, idiopathic thrombocytopenic purpura (ITP), and hemophilia impair the blood’s ability to form clots. This leads to excessive bruising and purpura.
Medications
Blood thinners and aspirin can thin the blood too much, allowing vessels to leak blood into the skin more readily. Steroids like prednisone also make blood vessels fragile.
Infections
Bacterial infections like meningitis, Rocky Mountain spotted fever, and endocarditis can damage blood vessels and produce purpura rashes. Viral infections may also be a cause.
Autoimmune disorders
Autoimmune diseases like lupus, rheumatoid arthritis, and vasculitis attack healthy blood vessels. This can lead to purpura.
Blood clotting disorders
Conditions like thrombotic thrombocytopenic purpura (TTP) and disseminated intravascular coagulation (DIC) disrupt normal blood clotting. This allows vessels to leak blood into the skin.
Senility
Aging causes blood vessels to weaken. In older adults, minor trauma can lead to senile purpura, especially on the forearms, hands, and legs.
Liver disease
The liver produces proteins involved in blood clotting. Liver damage or disease can impair clotting and result in purpura.
Diagnostic blood tests looking at platelet counts, clotting factors, and autoantibodies can help pinpoint the cause of purpura. A skin biopsy may also be done. Treating any underlying condition is the mainstay of resolving symptomatic purpura spots.
What vitamin deficiencies cause purpura?
Of the many potential causes of easy bruising and excessive purpura, two main vitamin deficiencies stand out:
Vitamin C deficiency
Also called ascorbic acid deficiency or scurvy, vitamin C deficiency affects the collagen in blood vessel walls. Collagen provides strength and integrity to all tissues in the body. Without enough vitamin C, collagen production is impaired.
Blood vessels become fragile and prone to bleeding under the skin, leading to purpura and bruising. Even minor trauma can lead to purpura spots. Vitamin C deficiency may also cause bleeding gums, nosebleeds, painful joints, and slow wound healing.
Vitamin K deficiency
Vitamin K is essential for the liver to produce proteins involved in blood clotting. The main clotting proteins are:
– Prothrombin
– Factor VII
– Factor IX
– Factor X
Without enough vitamin K, these clotting factor levels fall. This impairs the blood’s ability to clot after an injury to a blood vessel. The vessel continues leaking blood under the skin, producing purpura spots.
In addition to purpura and bruising, vitamin K deficiency can result in:
– Excessive bleeding from wounds
– Bloody urine or stools
– Heavy menstrual bleeding
– Anemia
Sever vitamin K deficiency in infants can lead to a bleeding disorder called vitamin K deficiency bleeding (VKDB). This causes severe purpura and bleeding shortly after birth. VKDB is prevented by giving newborns a vitamin K injection shortly after delivery.
How are vitamin C and K deficiencies diagnosed?
A doctor will start by reviewing symptoms and performing a physical exam to look for purpura spots. They will ask about potential risk factors like:
– Poor diet lacking fruits/vegetables
– Malabsorption conditions
– Liver disease
– Medications like blood thinners
Blood tests help confirm vitamin C and K deficiency:
Vitamin C
– Plasma ascorbic acid level – Levels below 0.2 mg/dL indicate deficiency
Vitamin K
– Prothrombin time (PT) – Elevated PT suggests impaired clotting
– International normalized ratio (INR) – Elevated INR also indicates poor clotting
– Specific blood clotting factor levels – Levels of factors produced by the liver may be reduced
These lab markers help distinguish vitamin K deficiency from other clotting disorders. A complete blood count looking at red blood cells and platelets may also be done to check for anemia or thrombocytopenia.
How are vitamin C and K deficiencies treated?
The main treatment for vitamin C and K deficiency is supplementing with the vitamin:
Vitamin C
– Vitamin C supplements by mouth, typically 1,000 mg per day
– For severe deficiency, injections may be given
– Supplements should continue for 1-2 months after symptoms resolve
– Dietary sources – citrus fruits, strawberries, tomatoes, broccoli and fortified cereals
Vitamin K
– Vitamin K supplements by mouth, dose based on lab values
– Intravenous vitamin K injections may be given for quicker effect
– Supplements often needed for several weeks
– Dietary sources – leafy greens like kale and spinach, broccoli, prunes, certain oils
People with malabsorption conditions or liver disease may require higher doses or ongoing supplements to maintain adequate levels. Monitoring blood tests helps ensure treatment effectiveness.
Avoiding medications that thin the blood, like warfarin, helps prevent recurrent vitamin K deficiency. Treating any underlying medical condition can also improve vitamin absorption and blood vessel integrity.
Conclusion
Purpura, or red/purple spots on the skin, has many potential causes. Two vitamin deficiencies known for causing easy bruising and excessive, symptomatic purpura are vitamins C and K deficiency.
Vitamin C deficiency, also called scurvy, leads to weak blood vessels that are prone to rupture. Vitamin K deficiency impairs the liver’s production of clotting factors. Both of these scenarios allow blood vessels to leak blood into the skin, forming purpura.
Diagnostic blood tests can detect vitamin C and K deficiency. Treatment involves supplementing with these vitamins, often for several weeks or more. Getting enough through diet or possibly ongoing supplements helps prevent recurrence of deficiency. Treating any associated medical conditions also helps stabilize blood vessels and improve clotting.