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3 Table 1 Clinical Characteristics of 9 Patients with Senile Purpura and 4 Patients with Steroid Purpura
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5 Fig. 1 Normal Dermal Terminal Arteriole from Buttock Skin of a 62-Year-Old Male (A) Higher Magnification of Portion of Vascular Wall (B) L=lumen. R=red blood cell. E= endothelial cell. P=pericyte. V=veil cell. M= smooth muscle cell. Arrowheads indicate basement membrane. Fig. 2 Normal Dermal Venous Capillary from Thigh Skin of a 17-Year-Old Female Pericytes (p) are invested by basement membrane of vascular wall (A). Higher Magnification of Portion of Vascular Wall (B). Arrowheads indicate lamellae in multilaminated basement membrane. E=endothelial cells. V=veil cell.
6 Fig. 3 A Light Photomicrograph of Dorsal Hand Skin from a Patient with SenilePurpura (case 1) Surface contour is flat. The rete ridges are flattened (A, H & E, ~ 100). B shows some actinic damage, the elastic matrix is more irregular, matted together, and appears to be increased compared to the amount of collagen in the dermis (elastica-van Gieson, ~ 100). Arrowheads indicate thickened vascular wall by deposition of PASpositive material (C, PAS, ~ 100). Fig. 4 A Light Photomicrograph of Forearm Skin from a 62-Year-Old Patient (Case 13) with Steroid Purpura (A, H & E, ~ 200) A marked increase of elastic fiber in the upper and mid-dermis (B, elastica-van Gieson, ~ 100).
7 Fig. 5 Thickened Postcapillary Venule in the Dorsal Hand Skin of Case 3 (A) Gap (arrowheads) is seen between endothelial cells. The basement membrane is directly exposed to the vascular lumen (B). E= endothelial cells. P=pericyte. V= veil cell. * =layer of basement membrane-like material being deposited on the periphery of vascular wall.
8 604 皮 膚 第36巻 第5号 平 成6年10月 A B Fig. 6 Postcapillary Venule in the Extensor Forearm Skin of a 72-Year-Old Patient (Case 6) with Senile Purpura (A) Higher Magnification of Portion of Vascular Wall (B) E= endothelial cells. P=pericytes.*=layer of basement membrane-like material admixed with reticulin fibers.
9 Fig. 7 A venous capillary and surrounding connective tissue from a 57-year-old patient (case 2) with senile purpura. Deposition of amorphous material (a) at the periphery of the vassel is seen (uranyl acetate & lead citrate). Inset: elastic fiber (e) and collagen fiber (c) (tannic acid & lead citrate). R=extravasated red blood cell. Fig. 8 Terminal Arteriole in the Dorsal Hand Skin of a 76-Year-Old Patient (Case 1) with Senile Purpura (A, uranyl acetate & lead citrate) Higher Magnification of Portion of Vascular Wall Homogeneous band of basement membrane (arrowheads) is seen (B). E=endothelial cell. M=smooth muscle cell.
10 Fig. 9 Venous Capillary in the Chest Skin of a 81-Year-Old Patient (Case 11) with Steroid. Purpura (A, uranyl acetate & lead citrate). Higher Magnification of Portion of Vascular Wall Homogeneous-appearing basement membrane (arrowheads) is seen (B). E=endothelial cells. P=pericyte. *= basement membrane-like material of the adjacent postcapillary venule.
11 皮 膚 第36巻 第5号 平 成6年10月 607 A B Fig. 10 Postcapillary Venule in the Forearm Skin of a 78-Year-Old Patient (Case 12)with Steroid Purpura Deposition of amorphous material is minimal (A, uranyl acetate & lead citrate). Venous Capillary and its Surrounding Connective Tissue Fragmentation of elastic fibers (e) is seen (B, tannic acid & lead citrate). E= endothelial cell. V=veil cell. R=extravasated red blood cell.
12 Fig. 11 Postcapillary Venule in the Forearm Skin of a 62-Year-Old Patient (Case 13) with Steroid Purpura (A, uranyl acetate & lead citrate) Higher Magnification of Portion of Vascular Wall. Single layer of basal lamina is seen. Deposition of amorphous material is minimal (B). Elastic fibers are seen in aggregation in the mid-dermis (C, tannic acid & lead citrate). E=endothelial cell. P= pericyte. V=veil cell. M=mast cell.
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14 1. Shuster S, Scarborough H: Senile purpura, Q J Med, 117: 33-40, Lavker RM: Structural alterations in exposed and unexposed aged skin, J Invest Dermatol, 73:59-66, Fenske NA, Lober CW: Structural and functional changes of normal aging skin, J Am Acad Dermatol, 15: , Smith L: Histopathologic characteristics and ultrastructure of aging skin, Cutis, 43: , Pochi PE, Strauss JS, Downing DT: Age-related changes in sebaceous gland activity, J In- 19. Rand JA, Gordon RE, Sessman I et al: Electron vest Dermatol, 73: , 1979 microscopic localization of factor VI-related anti- in adult human blood vessels, gen Blood, 60: , Wagner DD, Olmsted JB, Marder VJ: Immunolo- 8. Imayama S, Braverman IM: A hypothetical explanation for the aging of skin, Am J Pathol, 134: , Tsuji T, Hamada T: Age-related changes in human dermal elastic fibres, Br J Dermatol, 105: 57-63, Bouissou H, Pieraggi MT, Julian M, Savit T: The elastic tissue of the skin. A comparison of spontaneous and actinic (solar) aging, Int J Dermatol, 27: , Fleischmajer R, Perlish JJ, Bashey RI: Aging of human skin, Frontiers of Matrix Biology (Pobert CL Ed), 1, S Karger, Basel, 1973, Montagna W, Carlisle K: Structural changes in ageing skin, Br J Dermatol, 122 (Suppl 35) : 61-70, Montagna W, Carlisle K: Structural changes in aging human skin, J Invest Dermatol, 73: 47-53, Tsuchida Y: The effect of aging and arteriosclerosis on human skin blood flow, J Dermatol Sci, 5: , Kajikawa K, Yamaguchi T, Katsuda S, Miwa calization of von Willebrand protein in Weibel- Palade bodies of human endothelial cells, J Cell Biol, 95: , Braverman IM, Keh-Yen A: Ultrastructure of the human dermal circulation; III. The vessels in the mid- and lower dermis and subcutaneous fat, J Invest Dermatol, 77: , Ebling FJG, Eady RAJ, Leigh IM: Anatomy and organization of human skin, Textbook of Dermatology (Champion RH, Burton JL, Ebling FJG Eds), 1, 5th Ed, Blackwell Scientific Publications, London, 1992, Tsuji T, Yorifuji T, Hayashi Y, Hamada T: Light and scanning electron microscopic studies on wrinkles in aged persons' skin, Br J Dermatol, 114: , Braverman IM, Fonferko E: Studies in cutaneous aging; I. The elastic fiber network, J Invest Dermatol, 78: , Feinstein RJ, Halprin KM, Penneys NS, Taylor JR, Schenkman J: Senile purpura, Arch Dermatol, 108: , Braverman IM, Fonferko E: Studies in cutaneous aging; II. The microvasculature, J Invest Dermatol, 78: , Braverman IM, Keh-Yen A: Ultrastructural
15 31. Kumakiri M, Hashimoto K, Willis I: Biologic changes due to long-wave ultraviolet irradiation on human skin; ultrastructural study, J Invest Dermatol, 69: , Braverman IM, Sibley J, Keh-Yen A: A Study of the veil cells around normal, diabetic, and aged cutaneous microvessels, J Invest Dermatol, 86:57-62, Champion RH: Purpura, Textbook of Dermatology (Champion RH, Burton JL,Ebling FJG Eds), 3, 5th Ed, Blackwell Scientific Publications, London, 1992,
16 Senile Purpura: A Light and Electron Microscopic Investigation of Dermal Microcirculation and Connective Tissue with Reference to Steroid Purpura Haruhis a Kato Division of Dermatology, Hoshigaoka Koseinenkin Hospital 4-8-1, Hoshigaoka, Hirakata 573, Japan Key words : senile Purpura-steroid purpura-dermal microvasculature-electron microscopic study Senile purpura is well-defined ecchymoses originating on the backs of the hands and forearms of the elderly by shear forces. Histopathologically it shows solar elastosis in the upper dermis and atrophy in the lower portion. Long-term corticosteroid therapy is also one of the predisposing factors of purpura. Such conditions are designated as steroid purpura. However, these types of purpura had never been studied ultrastructurally. Morphological alterations of the dermal microvasculature and the surrounding connective tissue in senile purpura of 9 elderly patients (7M, 2F, aged years) and steroid purpura of 4 patients (3M, 1F, aged years) were investigated using electron microscopy. The following observations were made. In senile purpura, the vascular wall of venous segment in the upper dermis was most severely thickened. The postcapillary venules were more severely involved than the arterioles and capillaries. The thickening of the wall was resulted from a perivascular deposition of basement membrane-like material, composed of multilayered basal lamina and amorphous material admixed with individual collagen fibers. In contrast, the arterioles were less affected and a layer of homogeneous-appearing basement membrane was seen. The dermal connective tissue was very sparse, and seemed to lose their architectural integration. Opening of endothelial junctions and extravasation of red blood cells were seen. In steroid purpura, vascular wall thickening was minimal compared to that seen in senile purpura, however, the connective tissue around the vessels was as loose and sparse as that seen in senile purpura. These findings strongly suggest that vascular wall thickening of venous segment of dermal microcirculation reduces elasticity of blood vessels in senile purpura. Disintegration of collagen and elastic fibers fails to support the dermal microvasculature, resulting in vascular disruption by shear forces both in senile purpura and steroid purpura.
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