CASE REPORT
A58-year-old male with multiple medical problems, including a 15 year history of idiopathic thrombocytopenia (ITP), presented with violaceous lesions on the scalp and upper face. The patient initially noticed bruise-like patches on his scalp but discounted these as a reaction to a hair styling product. When the lesions did not improve, he sought evaluation by his internist who attributed the lesions to trauma in the setting of underlying ITP or a latex-related reaction to the straps on his continuous positive airway pressure mask. The patches progressively increased in size, prompting referral to dermatology four months after initial presentation. The patient denied pain, bleeding, itching, and constitutional symptoms. On physical examination, a 3 cm indurated, deeply violaceous vascular plaque with scant scale was noted on the right temple with adjacent violaceous, satellite lesions on the right lateral forehead (Figure 1). Surrounding these lesions were large, confluent violaceous patches extending onto the right temporal, frontal, parietal, vertex, and superior occipital scalp (Figures 2, 3, 4). Small violaceous macules were scattered on the forehead with prominent bilateral periocular edema (Figure 1 and 2). No lymphadenopathy was palpable in the cervical chains or supraclavicular basins.
