Multiple purpura like patch on legs below waist. The area is excessive itchy and is giving burning sensation. What can be the diagnosis
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itchy purpura legs differential diagnosis non blanching rash vasculitis reputable medical source
A diagnosis cannot be made safely without examining the rash, but purpura on the lower legs with burning and itch raises concern for cutaneous small-vessel vasculitis (also called leukocytoclastic or hypersensitivity vasculitis). It often causes purple, non-blanching spots or raised patches on the legs, and can cause burning, swelling, and itch. DermNet’s overview describes this pattern.
Other possibilities include:
- Allergic/contact dermatitis or insect bites with bruising from intense scratching
- Pigmented purpuric dermatosis/capillaritis, often harmless but usually more chronic
- Medication-related rash, including from a recently started antibiotic, painkiller/NSAID, blood thinner, or supplement
- Low platelets or a bleeding/clotting problem
- IgA vasculitis, particularly if there is abdominal pain, joint pain, or blood/darkness in urine
Please arrange an in-person medical assessment today or within 24 hours, preferably with a clinician/dermatologist. They may need to check whether the lesions blanch, feel raised, and do blood count, kidney/urine tests, and sometimes a skin biopsy.
Go to urgent care/emergency now if any of these apply:
- Fever or feeling seriously unwell
- Rash spreading quickly, black areas, blisters, ulcers, or severe pain
- Bleeding from gums/nose, unusual bruising, dizziness
- Shortness of breath or facial/lip swelling
- Abdominal pain, vomiting, joint swelling, blood in urine, or reduced urine
- You take blood thinners, have a low platelet condition, or are immunocompromised
Until assessed: avoid scratching and avoid starting steroid creams, antibiotics, or anti-inflammatory pain medicines on your own. Take photos in good light, note any new medicines, infection/sore throat, foods, creams, or exposures during the last 1-3 weeks, and bring that information to the visit.
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