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11/5/2020

Capillaritis
Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1999. Updated January 2016.

Capillaritis — codes and concepts open

What is capillaritis?
Capillaritis is a harmless skin condition in which there are reddish-brown patches caused by leaky
capillaries. It is also known as pigmented purpura.

Capillaritis

Schamberg purpura Close-up of lower back Capillaritis

See more images of capillaritis

Who gets capillaritis?

Capillaritis can a ect anyone, but is uncommon in children.

It usually a ects otherwise healthy people.

Occasionally capillaritis arises as a reaction to a medication; many di erent drugs have been
occasionally associated with capillaritis including meprobamate, carbamazepine and carbromal. 
In others a food additive or a viral infection may be responsible.
Capillaritis may also develop after exercise.

What causes capillaritis?

The capillaries are small blood vessels near the skin surface. For unknown reasons they sometimes
become in amed, although a true vasculitis is not seen on skin biopsy. Blood cells may pass through small
gaps that arise between the cells, which make up the capillary walls. The result is petechial haemorrhages.
These fade away depositing haemosiderin in the upper parts of the dermis.
What are the clinical features of capillaritis?
Capillaritis is classi ed according to its appearance. It is characterised by tiny red and brown dots,
described as cayenne pepper spots. These may be scattered over a body region or group together to form
a at red patch, which becomes brown and then slowly fades away over weeks to months. The clinical
descriptions are named after the dermatologist who rst described them

Schamberg disease (progressive pigmented purpura)

Schamberg disease is the most common type of capillaritis. Regular or irregular crops of red-brown at
patches with cayenne pepper spots on their borders appear for no apparent reason. Although most
common on the lower legs, the Schamberg form of capillaritis can arise on any part of the body. It is usually
irregularly distributed on both sides with few or many patches. There are no symptoms.

Doucas-Kapetanakis eczematid-like purpura (itching

purpura)

Doucas-Kapetanakis eczematid-like purpura appears similar to Schamberg disease, but itches. Reddish-

purple macules appear around the ankles and may spread up the legs. Itching purpura can also a ect
trunk and upper limbs. Itching leads to scratching and licheni cation.

Gougerot-Blum purpura (pigmented purpuric lichenoid

dermatosis)

Gougerot-Blum capillaritis is less common. The patches are thickened and itchy, rather like eczema, but
pathology is of a lichenoid reaction.

Majocchi purpura (purpura annularis telangiectodes)

In this condition there are dilated capillaries as well as brown patches and cayenne spots. Annular patches
gradually spread outwards and form concentric rings.

Majocchi purpura

Purpura annularis
telangiectodes of
Majocchi
Contact allergy
Capillaritis has been reported to be due to khaki clothing dye and to rubber. It only a ects skin in contact
with the responsible material.

Lichen aureus
Lichen aureus is a solitary brown-yellow patch that is very persistent. It often overlies a varicose vein.

Lichen aureus

Capillaritis

Exercise-induced capillaritis

Capillaritis may develop on the ankles following prolonged or vigorous exercise (eg, after 18 holes of golf,
tramping, or dancing), especially during warm weather. The spots fade to brown within a few days and
eventually disappear. A burning sensation may occur as the new lesions appear. Exercise-induced
capillaritis can occur on a single occasion or recur regularly after exercise.

Exercise-induced capillaritis

Golfer's capillaritis

How is capillaritis diagnosed?

Capillaritis is usually a clinical diagnosis. The diagnosis may be supported by dermatoscopy (the petechiae
are seen more clearly) and skin biopsy. No other investigations are necessary in most cases. See also lichen
aureus pathology.

What is the treatment for capillaritis?

As capillaritis is a mild condition, most patients do not require treatment. There is no known cure.

Consider if a medication could be the cause: discontinue it for several months to nd out if the
capillaritis improves.
Try avoiding food preservatives and arti cial colouring agents. Return to a normal diet if there is no
improvement after several months.
Topical steroids can be helpful for itching.
Phototherapy can be e ective at clearing capillaritis but do not prevent it recurring.
If the lower leg is a ected, consider wearing graduated compression elastic hose. This is helpful to
reduce exercise-induced capillaritis.
Currently available vascular lasers are not particularly helpful for capillaritis.

What is the outcome for capillaritis?

Capillaritis can disappear within a few weeks, recur from time to time, or persist for years.

Related information
 

On DermNet NZ
Vascular skin problems
Cutaneous vasculitis
Small vessel vasculitis
Exercise-induced vasculitis
Purpura
Lichen aureus pathology

On other websites
Pigmented Purpuric Dermatitis – Medscape Reference

Books about the skin

See the DermNet NZ bookstore.

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