[Acral purpura and hyperhomocysteinemia].
BACKGROUND
Increased level of homocysteine has been shown to be associated with atherosclerotic disease and venous thrombosis. There are only exceptional reports of cutaneous disease due hyperhomocysteinemia.


METHODS
A 71-year-old man presented with an acral purpura mainly located under the nail plates and resulting in onycholysis. Histologic examination of a skin biopsy specimen showed thromboses of dermal vessels without vasculitis. Laboratory tests revealed highly elevated homocysteinemia due to a mutation in the methylene-tetra-hydrofolate-reductase gene. No other cause of purpura or thrombophilia was found. When oral folic acid was given, both homocysteinemia and cutaneous lesions were controlled. However, a biological and clinical recurrence occurred when therapy was discontinued.


CONCLUSIONS
Hyperhomocysteinemia has probably a causal role in this original case of acral purpura. Since treatment is effective, the detection of hyperhomocysteinemia should be proposed in patients with cutaneous lesions secondary to distal vascular thromboses.
Boeckler
P
P
Service de Dermatologie, Hôpital Pasteur, Colmar.
Grange
F
F
Krzisch
S
S
Grosshans
E
E
Guillaume
J-C
JC
D000368:Aged; D001706:Biopsy; D005492:Folic Acid / Q000008:administration & dosage / Q000494:pharmacology; D006397:Hematinics / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D008297:Male; D009262:Nails / Q000473:pathology; D011693:Purpura / Q000209:etiology* / Q000473:pathology; D012008:Recurrence
D006397:Hematinics; D005492:Folic Acid