Angulated (Retiform) Purpura

These result from complete vascular occlusion and vascular damage with leakage of red blood cells into the skin (the angulated shape reflects the vascular architecture in the skin). Skin necrosis secondary to infarction may be seen. In this case, the patient was presenting with antiphospholipid antibody syndrome. Other rheumatologic causes include vasculitis that involves medium-sized vessels eg. cryoglobulinemic vasculitis. Other causes may include embolic disorders, DIC, warfarin induced necrosis and several others. (Image Credit: Dr. Lori Albert)