Pigmented purpuric dermatosis in children: a retrospective cohort with emphasis on treatment and outcomes

Background Data regarding the course and treatment of pigmented purpuric dermatoses (PPD) in the paediatric population are limited. Although treatments for pigmented purpura are not well established, vitamin C and rutoside have been reported to be an effective treatment option and are widely utilized. Objective To assess the clinical course and utility of vitamin C and rutoside in paediatric patients with PPD treated at Ann & Robert H. Lurie Children’s Hospital of Chicago between 2008 and 2018. Methods A retrospective review of all children with PPD managed at our hospital between 2008 and 2018 was performed. Additional follow‐up was obtained via telephone interviews. Results A total of 101 patients met inclusion criteria. The female: male ratio was 1.3 : 1, and the median age at diagnosis was 8.8 years (IQR, 5.7–12.9). Median follow‐up was 7.13 months (IQR, 3–17.4). The most common PPD subtypes were lichen aureus (43%) and Schamberg (34%). Fifty‐three (52%) patients had evaluable follow‐up documentation via their medical record or phone questionnaire. Twenty‐eight patients were treated with vitamin C or rutoside or combination therapy. Twenty‐five patients received no treatment. Clearance of the rash was noted in 24 (45.3%) patients overall, including 10 (42%) patients in the treated group and 14 (58%) patients in the untreated group. Recurrence was noted in seven (13.2%) patients. Treatment with vitamin C and/or rutoside was well tolerated without side effects. None of the patients were subsequently diagnosed with vasculitis, coagulopathy or cutaneous T‐cell lymphoma. Conclusion Pigmented purpuric dermatosis in children is a benign disorder with high rates of complete resolution. Treatment with vitamin C and rutoside is well tolerated, but in this cohort, there did not appear to be an advantage over watchful waiting without therapy.