Clinical management of pigmented purpuric dermatoses: evidence from a survey among the Study Group on Cutaneous Vascular Diseases of the Italian Society of Dermatology and Venereology

Abstract

Background: Pigmented purpuric dermatoses (PPD) are a group of chronic, benign skin conditions with limited evidence-based data regarding their diagnosis and management. The aim of our work was to evaluate the clinical practices of dermatologists in managing PPD, focusing on patient presentation, treatment preferences, and the need for further diagnostic evaluations.

Methods: We utilized a survey-based design for the present study. The survey was distributed to the Study Group on Cutaneous Vascular Diseases and Skin Ulcers of the Italian Society of Dermatology and Venereology. The survey collected data on the number of patients evaluated weekly, the proportion of patients requesting treatment, preferred therapeutic approaches, and indications for additional diagnostic tests.

Results: Twenty-four clinicians from 11 centers participated. Respondents reported managing an average of 5 PPD cases per week, with treatment required in approximately 50% of cases, while the remainder were incidental findings during evaluations for other dermatological conditions. Skin moisturizers and topical corticosteroids (tCS) were universally recommended as first-line treatments. Additional therapies included zinc oxide cream, compression stockings, and flavonoid-based oral supplements. Further diagnostic workups, such as leg Doppler ultrasound, skin biopsy, and blood tests, were considered necessary only in selected patients based on clinical presentation and comorbidities.

Conclusions: Moisturizers and tCS are the cornerstone of PPD treatment, supplemented by tailored therapies and diagnostic evaluations. These findings highlight the need for standardized, evidence-based guidelines to optimize the management of PPD.