AT A GLANCE
A new survey of Italian dermatologists reveals current practices in diagnosing and treating pigmented purpuric dermatoses, showing strong consensus on first-line use of moisturizers and topical corticosteroids but wide variability in adjunctive care and diagnostic evaluation.

Pigmented purpuric dermatoses (PPD) are chronic, benign vascular skin disorders characterized by reddish-brown macules and petechiae, yet their management remains largely empirical due to limited evidence-based guidance. This national survey conducted by the Study Group on Cutaneous Vascular Diseases of the Italian Society of Dermatology and Venereology explored how clinicians diagnose and treat PPD in routine practice. Across 24 dermatologists from 11 centers, respondents reported encountering an average of five cases per week—half of which required active treatment, including the use of topical corticosteroids, while others were incidental findings.

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Topical corticosteroids and emollients were consistently identified as mainstays of therapy, providing symptomatic relief and improvement in skin appearance. Adjunctive treatments such as zinc oxide, compression therapy, and flavonoid-based oral supplements were used selectively to target vascular inflammation and support microcirculation. Diagnostic workups—including Doppler ultrasound, biopsy, and laboratory panels—were generally reserved for patients with atypical presentations or underlying comorbidities. Collectively, the findings highlight significant heterogeneity in PPD management and emphasize the unmet need for standardized, evidence-driven clinical guidelines to harmonize care and improve patient outcomes.

Reference: Paganelli A, Michelerio A, Collina MC, et al.; Study Group on Cutaneous Vascular Diseases and Skin Ulcers of the Italian Society of Dermatology and Sexually Transmitted Diseases (SIDeMaST). 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. Ital J Dermatol Venerol. 2025 Oct;160(5):406-412. doi: 10.23736/S2784-8671.25.08243-X. PMID: 41041874.