Table 3.

Differential diagnosis of petechial/purpuric eruptions.

Differential Points	Petechial/Purpuric Eruptions	Leukocytoclastic Vasculitis	Glove and Stocking Purpura
Fever	Usually accompanied by fever symptoms.	May be accompanied by fever.	Fever.
Skin rash	Commonly found at the extremities.	Mainly involves the lower legs, but dependent areas such as the back may also be affected in hospitalized patients.	Edema, erythema and pruritic petechiae and papules in a distinct ‘glove and sock’ distribution. Usually associated with systemic symptoms, including fever, swollen lymph nodes, malaise, myalgia and arthralgia [33].
Itching	Not yet been reported.	May be completely asymptomatic. May present as burning pain.	Acral pruritus and pain [34].
Recurrence	Usually no recurrence.	Recurrence rate less than 20%.	Generally, no recurrence.
Duration	Mostly fades within 2 weeks.	Fades and slowly disappears within 2–3 weeks, leaving post-inflammatory hyperpigmentation.	Disappears within 1–2 weeks.
Histopathological features	The preferential involvement of the stratum granulosum and the upper half of the stratum spinosum. Intraepidermal vesiculation and reticular degeneration of cleared out spaces between cells. The keratinocytes showed marked eosinophilia with loss or diminution of the normal nuclear basophilic staining, resulting in a somewhat ‘ghost cell’-like appearance, consistent with necrosis. The lower third of the epidermis was also involved to a much lesser degree [29].	Evidence of neutrophilic infiltration within and around the vessel wall with signs of leukocytoclasia (disintegration of neutrophil nuclei into fragments or nuclear dust). Fibrinoid necrosis (fibrin deposition within and around the vessel walls). Signs of damage to the vessel wall and surrounding tissue (extravasated red blood cells, damaged endothelial cells) [31].	A mixed pattern of inflammation with interface and spongiotic changes. Parakeratotic scale with overlying basket-weave orthokeratosis. Within the epidermis, there were intraepidermal vesicles and Langerhans cell microabscess formations with scattered apoptotic keratinocytes. The underlying dermis showed a superficial perivascular lymphocytic infiltrate with mild edematous changes and extravasation of red blood cells [32].
Pathogens	CVA6.	Vasculitis of small vessels with inflammatory infiltration of neutrophils with leukocyte fragmentation.	Parvovirus B19.
Prevalence age	Commonly seen in patients over 5 years of age.	Tends to favor older patients and male patients.	Most prevalent in young adults.