Therapeutics in Dermatology
A reference textbook in dermatology

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Painful bruising (syndrome)

10 April 2012, by CONSOLI S.G.

Painful bruising syndrome, also known as Gardner–Diamond syndrome, psychogenic purpura or autoerythrocyte sensitisation, is a rare condition characterised by the spontaneous appearance, most often in women and primarily on the arms and legs, of painful ecchymoses which are heralded by skin reactions such as pruritus, or a burning or tingling sensation, followed by inflammatory erythema and oedema, and sometimes accompanied by various somatic disorders. Generally, no laboratory abnormalities are observed and no organic causes are found on objective examination. However, in the vast majority of cases, painful bruising syndrome occurs in patients with personality disorders, following physical trauma or surgery or following a severe psychoemotional shock and the condition is associated with various psychiatric disorders (particularly depression and/or anxiety [11]).

Several etiopathogenic hypotheses have been put forward. In some cases, etiopathogenesis is thought to be somatic and associated with sensitisation to the stroma of the patients’ own erythrocytes or, more recently, with the dysfunction of neuromediators within the neuro-immuno-cutaneous network [9]. In other cases, etiopathogenesis is thought to be psychological with some authors considering the condition psychosomatic and others, factitious. Irrespectively, the factors responsible for triggering painful bruising syndrome are still unexplained and its nosology is vague, perhaps because the practitioners confronted with the condition come from different backgrounds and do not work together frequently enough. Under these conditions, it is easy to understand why a great number of different treatments have been used, giving rise to only temporary and non-reproducible improvements in cases where improvements were observed [12].

Currently, the best treatment results are obtained following implementation of a double treatment strategy, i.e. one that is both somatic and psychological.

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