Purpura fulminans is an acute, often fatal, thrombotic disorder which manifests as blood spots, bruising and discolouration of the skin resulting from coagulation in small blood vessels within the skin and rapidly leads to skin necrosis and disseminated intravascular coagulation. Causes
Purpura fulminans is caused by defects in the protein C anticoagulant pathway. Identification of the cause of purpura fulminans often depends on the patients age and circumstances of presentation. Congenital protein C deficiency
Congenital (inherited) defects in protein C activity are autosomal dominant and may be partial or severe loss of function. Hundreds of natural mutations of the protein C gene (PROC) have been identified. Acquired protein C deficiency
Acquired protein C deficiency is caused by either depletion of available protein C in plasma or decreased protein C synthesis (caused by administration of vitamin K antagonists, severe liver failure or complications of prematurity). Severe acute sepsis
Purpura fulminans is a presenting feature of severe acute sepsis, such as Neisseria meningitidis, Streptococcus pneumoniae, Group A and B Streptococci, and less commonly with Haemophilus influenzae, Staphylococcus aureus, or Plasmodium falciparum (malaria) infections, particularly in individuals with asplenia. Combination of sepsis and partial congenital defect
In some cases, a combination of sepsis and a partial congenital defect in the protein C anticoagulant pathway initiates purpura fulminans. Unknown
In rare instances, purpura fulminans is an autoimmune manifestation against protein C or protein S after normally benign infections, such as chicken pox. Sometimes purpura fulminans has unknown cause.
These interventions focuses on incorporating lifestyle changes which include: switching to loose-fitting clothes, using emollients, taking warm baths, avoiding harsh soaps, and maintaining good personal hygiene.If itching symptoms still persist, low to mid potency topical corticosteroids and first-generation antihistamines can be considered and may improve appearance of skin lesions. However, they may also not provide complete relief. Commonly used agents to treat pruritic folliculitis of pregnancy include: 10% topical benzoyl peroxide, 1% topical hydrocortisone, first generation H1 receptor blockers such as diphenhydramine or chlorpheniramine, and a short course of systemic corticosteroids such as prednisone.Narrowband ultraviolet B phototherapy has also been explored as a novel treatment option for pruritic folliculitis of pregnancy in one case study. Further investigation that leads to clinical trials is still required to understand the efficacy and safety of this unconventional treatment option.A comprehensive literature review using Medline and Cochrane Database relating to skin disease in pregnancy from 1990-2005 found that pruritic folliculitis of pregnancy has no associated morbidity for the mother or fetus and the condition will go away after pregnancy.An article from American Family Physician in 2007 states pruritic folliculitis of pregnancy has "no identified adverse effects" on pregnancy risks and that pruritic folliculitis of pregnancy can be treated using topical corticosteroids, topical benzoyl peroxide, or ultraviolet B light therapy. Clinical Studies and Case Reports
There was a case report about a 30 year old women who was in her tenth week of her second pregnancy. She had widespread papulopustular follicular eruption (rash involving hair follicles) mainly affecting her limbs.