Petechiae and non-palpable purpura (ecchymoses) secondary to medications occur as a result of hemorrhage into the skin. Except in those medications that lead to thrombocytopenia, petechial rashes are an unusual manifestation of drug eruption in pediatrics. Medications that cause thrombocytopenia or alter platelet function may manifest with petechiae and ecchymoses. Chemotherapeutic agents that cause generalized bone marrow suppression with thrombocytopenia are frequent culprits. Bleomycin has been reported to cause endothelial damage and leakage resulting in purpura. Anticoagulant therapy, serotonin reuptake inhibitors, and drug-induced vasculitis (leukocytoclastic vasculitis) may all present with dermal hemorrhage. Phenytoin, carbamazepine, and valproic acid may also cause purpura and vasculitis. Recently, the local anesthetic EMLA (eutectic mixture of lidocaine) has been described as causing petechiae and purpura at the sites of application with no alteration in hematologic indices.
Codes
ICD10CM: L27.1 – Localized skin eruption due to drugs and medicaments taken internally
SNOMEDCT: 109957002 – Drug-induced purpura
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