title: [Clinicopathological study of purpura: Is a skin biopsy necessary for palpable purpura?].
abstract: OBJECTIVE
  For many physicians, palpable purpura is synonymous with vasculitis. However, a skin biopsy is almost always performed in common clinical practice in order to confirm the diagnosis. The aim of our study was to assess whether palpable purpura is always indicative of an inflammatory infiltrate in a vessel wall.
  
  
  METHODS
  Eighty-seven patients were included in this prospective monocentric study, 45 of whom were presenting a palpable purpura. Patients were classified in two categories: "leukocytoclastic vasculitis" or "other diagnosis". The clinical and histopathological features of patients with a palpable purpura were studied.
  
  
  RESULTS
  The mean age of patients presenting a palpable purpura was 69 years. There were 26 men and 19 women. Of the 43 patients biopsied, 37 were included in the vasculitis group. The sensitivity, specificity, positive predictive value and negative predictive value for a diagnosis of vasculitis in patients with palpable purpura were respectively 82, 65, 86 and 58 %. The Odds ratio was 8.48 (95 % CI, 2.52-31.80; P<0.05).
  
  
  CONCLUSIONS
  Most of the palpable purpuras examined were indeed related to leukocytoclastic vasculitis. In the remaining cases, biopsy did not contribute to the diagnosis since it only showed purpura without vessel wall inflammation. In our opinion, a skin biopsy is thus not essential where the clinical presentation is typical.
authors.affiliation: Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: A-J
authors.initials: AJ
authors.lastname: Jung
authors.affiliation: Pôle de santé publique, secteur méthodologie et biostatistique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Schaeffer
authors.affiliation: Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Mitcov
authors.affiliation: Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Scrivener
authors.affiliation: Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Cribier
authors.affiliation: Clinique dermatologique, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France. Electronic address: dan.lipsker@chru-strasbourg.fr.
authors.forename: D
authors.initials: D
authors.lastname: Lipsker
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology*; D014657:Vasculitis / Q000175:diagnosis*
keywords: Biopsie cutanée; Leukocytoclastic vasculitis; Palpable purpura; Purpura palpable; Skin biopsy; Vasculite leucocytoclasique