Sir,

Pigmented purpuric dermatoses (PPD) represent a group of chronic cutaneous disorders that present with petechial hemorrhage occurring due to capillaritis. Extravasated erythrocytes result in purpura, and hemosiderin-laden macrophages give a red-brown appearance to older lesions. It is characterized by symmetrical petechial and pigmented macules, often confined to the lower limbs [1]. Although adults are more frequently affected, there are numerous reports of childhood PPD as well. Clinically, PPDs are categorized into five primary types: Schamberg disease (which is the commonest variant), pigmented purpuric lichenoid dermatosis of Gougerot and Blum, purpura annularis telangiectodes or Majocchi’s disease, lichen aureus and eczematid-like purpura of Doucas and Kapetanakis [2].

A 45-year-old female presented to the dermatology outpatient department with complaints of a reddish-brown rash on both lower limbs lasting for the previous one year. The rash was slowly progressive and initially asymptomatic but, one month previously, developed mild itching. There were no other significant findings in her family or personal history. Cutaneous examination revealed multiple reddish to brown macules along with several lesions showing central stippled puncta on the anteromedial aspect of both legs (Fig. 1). Dermoscopy revealed a reddish-brown background, brown globules with central, red dots giving a fried-egg appearance and scattered, coiled or punctuate vessels. Dermoscopic examination of two more patients with Schamberg’s disease was performed and showed a similar fried-egg appearance (Figs. 2a and 2b).

	Figure 1: Discrete to confluent reddish-brown “Cayenne pepper”-like patches on the left leg.
	Figure 2: a) Dermoscopy showing a reddish-brown background, brown globules with central red dots, and coiled vessels (Dinolite Edge, 60x). b) Dermoscopy showing a reddish-brown background, brown globules with central red coiled vessels showing the fried-egg appearance, red and brown dots. (Dinolite Edge, 200x).

The differential diagnosis of Schamberg’s disease includes leukocytoclastic vasculitis, contact dermatitis, early cutaneous T-cell lymphoma, hypergammaglobulinemic purpura of Waldenström, bleeding diathesis, stasis pigmentation, scurvy, and drug-hypersensitivity reactions [1]. A summary of clinical and dermoscopic features of differential diagnosis of Schamberg’s disease can be seen in Table 1 [2–7].

Table 1: A summary of clinical and dermoscopic features of the differential diagnosis of Schamberg’s disease [2–7].

Dermoscopy epiluminescence microscopy is a great non-invasive tool for evaluating pigmentary lesions as it often reduces the need for invasive tests such as a biopsy for diagnosis. The commonly noted dermoscopic findings of PPD include a coppery-red background, red dots, globules and patches, brown dots and globules, red dots, globules, and patches. Less common findings include a brown network, thick linear vessels, rosette structures, linear brown lines, and follicular openings [2,7]. The term fried-egg appearance in the context of Schamberg’s disease refers to the typical dermatoscopic pattern observed where red or reddish-brown vascular coiling is noted at the center of darker brown globules like the bright yellow yolk surrounded by the white of a fried egg. By reporting this novel finding, the authors wish to highlight a new observation of the fried-egg appearance, which has not been previously described to the best of the author’s knowledge and was seen typically in the patients with the Schamberg’s disease subtype of pigmented purpuric dermatoses.

REFERENCES

1.  Spigariolo CB, Giacalone S, Nazzaro G. Pigmented purpuric dermatoses:A complete narrative review. J Clin Med. 2021;10:2283.

2.  Ozkaya DB, Emiroglu N, Su O, Cengiz FP, Bahali AG, Yildiz P, Demirkesen C, Onsun N. Dermatoscopic findings of pigmented purpuric dermatosis. An Bras Dermatol. 2016;91:584-7.

3.  Gaurav V, Gowda P, Bahadur A, Tyagi H, Dev T, Barman KD. Dermoscopy-histopathology correlation of cutaneous small-vessel vasculitis. Cosmoderma. 2024;4:90.

4.  Sinha P, Ayub A, Krishnan L, Dash M. Mucocutaneous manifestations in a case of immune thrombocytopenia:Reporting a rare presentation with dermoscopic findings. Clin Dermatol Rev. 2024;8:375-7.

5.  Zaballos P, Salsench E, Puig S, Malvehy J. Dermoscopy of venous stasis dermatitis. Arch Dermatol. 2006;142:1526.

6.  Wambier CG, Cappel MA, Werner B, Rodrigues E, Welling MS, Netto MR, et al. Dermoscopic diagnosis of scurvy. J Am Acad Dermatol. 2017;76:S52-4.

7.  Metin M, Elmas Ö. Dermoscopic profile of pigmented purpuric dermatosis:New observations. Postepy Dermatol Alergol. 2019;36:687-91.