Psychogenic purpura, also known as recurrent painful bruising or
autoerythrocyte sensitization syndrome (Gardner-
Diamond syndrome) is usually associated with emotionally disturbed patients. It is a troublesome entity for both patient and physician since extensive work-ups yield no diagnosis. We describe two females in their early twenties with recurrent painful bruising and diverse accompanying symptoms which appeared after
physical trauma. One of the patients developed a
bruise after
intradermal injection of her own blood (with no reaction to saline injection). One patient had a personality (borderline) disorder, the other a factitious disorder. Punch biopsies revealed a perivascular inflammatory infiltrate, erythrocyte extravasation and no
vasculitis. Psychogenic
hemorrhagic disorders are uncommon yet must be considered in the differential diagnosis of
purpura. Patients are usually young emotionally troubled females who present painful recurrent
bruises on extremities frequently after
trauma or surgery. Autoimmune mechanisms and increased cutaneous fibrinolytic activity have been implicated, although further studies are needed. Correct diagnosis is important to avoid aggressive and even mutilating treatments, and an adequate comprehension of these
purpuras is important for the attending physician.