The purple digit: an algorithmic approach to diagnosis

American Journal of Clinical Dermatology
Patrick J BrownJoseph C English

Abstract

The acute onset of purple digits is a concerning manifestation and may represent underlying, potentially life-threatening disease. Correctly identifying the etiology of purple digits is essential to proper management, and can aid in the diagnosis of systemic disease. Multiple causes of purple digits and significant overlap in clinical presentation can make diagnosis difficult. Despite the various causes of acute purple digits in the published literature, an algorithmic approach to the evaluation and management of the most common and alarming etiologies has yet to be established. The initial step in evaluating a patient with purple digits is to determine if the cause is associated with hypoxemia or trauma. If the patient is in a stable condition, the dermatologist needs to determine if the process could be related to cold exposure such as Raynaud phenomenon, acrocyanosis, pernio, cryoglobulinemia or frostbite. If the disease occurs independent of temperature, physical examination and histological evaluation of the skin is recommended. The lack of peripheral pulses are concerning for acute arterial thrombosis from peripheral vascular disease or arterial embolism. Non-blanching skin changes on the digit that lack inflammation and ...Continue Reading

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Citations

Jul 16, 2014·Clinics in Dermatology·James E Song, Robert Sidbury
Mar 24, 2011·Vascular Medicine·Andrew K KurklinskyThom W Rooke
Jun 8, 2013·The EPMA Journal·Josef FlammerAndreas J Flammer
Sep 30, 2016·Vascular Medicine·Yasuhiro SuyamaMasato Okada
Jun 5, 2019·Vascular Medicine·Alejandro Godoy, Aldo Hugo Tabares
Jan 24, 2020·Advances in Skin & Wound Care·Asfandyar MuftiAfsaneh Alavi
Jul 24, 2020·Thrombosis Journal·Snehasis PradhanHans-Joachim Trappe
Feb 27, 2020·Case Reports in Rheumatology·Mateo Mejía-ZuluagaSebastián Herrera

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