Oral medication clears senile purpura
Boynton Beach, Fla. — A new experimental oral medication known as Purpurex (New Vitality) is effective in improving and even clearing the appearance of senile purpura, while helping to prevent new lesions from occurring, according to a recent study.
Thought to be due to an increased weakening in the connective tissues and blood vessels, senile — or Bateman's — purpura is a chronic condition commonly seen in individuals over age 50. Characterized by dark purple blotches of irregular form and size, the benign lesions are purely cosmetic lesions and typically a source of embarrassment.
"Patients with senile purpura (SP) tend to bruise very easily and develop ecchymoses appearing most commonly on the extensor surfaces of the forearms, legs and hands following suspected trauma to those areas. Until now, no effective treatments have been available to address the condition, let alone help prevent future lesions from occurring," says Joshua M. Berlin, M.D., Dermatology Associates P.A., Boynton Beach, Fla.
Dr. Berlin recently conducted a clinical trial evaluating the efficacy and safety of Purpurex in improving the skin's appearance in patients with SP. In the multicenter, randomized, placebo-controlled, double-blind study, 70 patients with SP were enrolled, of which 67 completed the trial.
Patients were randomized to receive either Purpurex, which consists of a nutraceutical citrus bioflavonoid blend (CBB) of ingredients, or placebo (calcium carbonate) twice daily in oral form for six weeks. A representative area of skin bruising located on either the right or left forearm, hand or leg was selected from each patient and its appearance documented with a high-resolution digital photograph.
Patients were assessed at baseline, two, four and six weeks.
Participants were permitted to take warfarin, clopidogrel or aspirin during the study if they were on these medications previously.
At the six-week follow up, a 50 percent reduction in the purpura lesions from baseline was seen in those patients receiving Purpurex, compared to a 9 percent increase in purpura lesions in the placebo group. Those patients receiving Purpurex showed a 19 percent, 29 percent and 50 percent decrease in purpura lesions at weeks two, four and six, respectively. No adverse effects were noted in both study arms by either the patients or the investigators.
"We believe that the steady decrease in the number of purpura lesions is due to a cumulative pharmacological effect of the supplement, the ingredients of which work synergistically to improve the appearance of SP and prevent new lesions from forming," Dr. Berlin says.
The citrus bioflavonoids such as rutoside and hesperidin are known to reduce capillary fragility and permeability as well as inhibit hyaluronase. Ascorbic acid is a prerequisite cofactor for collagen synthesis and is generally thought to play a role in maintaining capillary strength, he says.
One of the central ingredients of Purpurex is Arnica montana, which is known to help decrease capillary permeability and allow for the expedited clearing of extravasated red blood cells. Though there have been numerous studies about using arnica for the treatment of bruising, no significant improvement has been seen with arnica when used alone (Ernst E, Pittler H. Arch Surg. 1998;133(11):1187-1190; Kotlus BS, Heringer DM, Dryden RM. Ophthal Plast Reconstr Surg. 2010;26(6):395-397), Dr. Berlin says. When combined with the other ingredients of the CBB, however, the appearance of purpura can be significantly minimized in patients with SP.
"Senile purpura has plagued individuals for a long time, and truly effective therapies have been far and few between. With the increase in life expectancy and the increase in activity of the older generation, this cosmetic thorn has become more of an issue in contemporary times. Purpurex is the first-ever treatment for SP and fills this therapeutic void by effectively clearing the skin of the lesions and helping prevent newer ones from occurring," Dr. Berlin says.
The appearance of SP can also be caused and/or exacerbated by the use/overuse of anticoagulants such as aspirin, clopidogrel and warfarin; the long-term use of topical and oral corticosteroids; and standing comorbidities including diabetes and vascular diseases. These, as well as thrombocytopenia, scurvy and connective tissue diseases, must all be ruled out to help elucidate the pathogenesis of SP, Dr. Berlin says.
"Traditionally, it was thought that senile purpura was an incurable condition, barring the correction or removal of exacerbating factors. However, this novel supplement can actually help treat and prevent SP from occurring, representing a change in the conventional wisdom and paradigm shift in the way physicians view and treat these cosmetic lesions," he says.
Purpurex is an over-the-counter product that was expected to enter the market in September, Dr. Berlin says.
Disclosures: Dr. Berlin reports no relevant financial interests.