Current Dermatology Reports

, Volume 8, Issue 4, pp 245–257 | Cite as

An Approach to Retiform Purpura for the Inpatient Dermatologist

  • Abeer Alsarheed
  • Gabriela A. Cobos
  • Christine M. Cornejo
  • Ruth Ann Vleugels
  • Joseph F. MerolaEmail author
Hospital-Based Dermatology (L Guggina and A Zhou, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Hospital-based Dermatology


Purpose of Review

Retiform purpura is a potentially ominous cutaneous sign that develops secondary to vascular compromise by either vasculitis or a vasculopathic disorder. The wide array of associated complications mandate a thorough investigation in a timely fashion. This review provides an overview of the frequent causes of retiform purpura in hospitalized adult patients and proposes a diagnostic approach for the inpatient dermatologist.

Recent Findings

Early recognition of the primary cutaneous morphology in retiform purpura is especially important as this can help generate a focused differential and workup plan. A high-yield skin biopsy result warrants a proper site selection and an adequate depth. Further workup and treatment depend on the underlying pathogenic process. For patients with underlying systemic vasculitis, rituximab is emerging as an effective treatment. Rivaroxaban was found to have excess risk (increased thromboembolic and bleeding events) and no benefit when compared to warfarin in a trial of high-risk anti-phospholipid syndrome patients.


The differential diagnosis of retiform purpura is broad and a systematic approach is required to identify and treat the underlying cause.


Retiform purpura Vasculopathy Medium-sized vessel vasculitis Mixed-sized vessel vasculitis 


Compliance with Ethical Standards

Conflict of Interest

Abeer Alsarheed, Gabriela Cobos, and Christine Cornejo declare no conflict of interest.

Ruth Ann Vleugels reports grants from Pfizer.

Joseph Merola is a consultant and/or investigator for Merck Research Laboratories, Abbvie, Dermavant, Eli Lilly and Company, Novartis, Janssen, UCB, Samumed, Celgene, Sanofi Regeneron, GSK, Almirall, Sun Pharma, Biogen, Pfizer, Incyte, Aclaris, EMD Sorono and Leo Pharma.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Abeer Alsarheed
    • 1
  • Gabriela A. Cobos
    • 1
  • Christine M. Cornejo
    • 1
  • Ruth Ann Vleugels
    • 1
  • Joseph F. Merola
    • 1
    • 2
    Email author
  1. 1.Department of DermatologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Medicine, Division of RheumatologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

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