Case Report/Case Series |

A Case of Isotretinoin-Induced Purpura Annularis Telangiectodes of Majocchi and Review of Substance-Induced Pigmented Purpuric Dermatosis

Rachel Kaplan, MSEd1; Shane A. Meehan, MD2,3; Marie Leger, MD, PhD3
[+] Author Affiliations
1medical student, New York University School of Medicine, New York
2Department of Pathology, New York University Langone Medical Center, New York
3Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York
JAMA Dermatol. 2014;150(2):182-184. doi:10.1001/jamadermatol.2013.7371.
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Importance  Medications as well as chemical and food exposures have been causally linked to the development of pigmented purpuric dermatosis (PPD). We describe herein what is to our knowledge the first reported case of isotretinoin-induced PPD.

Observations  A woman in her 30s presented with purpura annularis telangiectodes of Majocchi on the lower extremities 2 months after initiating isotretinoin for the treatment of refractory nodulocystic acne.

Conclusions and Relevance  We believe isotretinoin was the most likely causative agent in this case because the lesions began after initiation of isotretinoin treatment and resolved shortly after its termination, and the pathologic findings were consistent with other described cases of drug-induced PPD. The lesions have continued to fade, and no new lesions have developed in a 3-month follow-up period. Drug-induced PPD is distinct from idiopathic PPD, and it is important to consider isotretinoin as a potential inciting agent.

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Figure 1.
Representative Annular Purpuric Lesion on the Patient’s Left Leg

The patient had several similar lesions on both lower extremities and buttocks. This red-brown lesion demonstrates the typical annular appearance of lesions in purpura annularis telangiectodes of Majocchi, with cayenne pepper–like punctate petechiae.

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Figure 2.
Histologic Appearance of Purpura Annularis Telangiectodes of Majocchi Lesion

A, There is a superficial perivascular lymphocytic infiltrate with extravasated erythrocytes (hematoxylin-eosin, original magnification ×100). B, Perls stain reveals hemosiderin deposits within the papillary dermis. These histologic findings are consistent with a diagnosis of pigmented purpuric dermatosis (original magnification ×400).

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