Extensive Purpura Annularis Telangiectodes of Majocchi in an Elderly Woman: Diagnostic Challenges in a Resource-Limited Hospital

Purpura annularis telangiectodes of Majocchi is a rare variant of pigmented purpuric dermatoses that primarily affects children and young women.It is characterized by asymptomatic, reddish-brown annular macules and patches, predominantly on the lower extremities.Its pathogenesis is not fully understood.Diagnosis is primarily clinical, although biopsy may be useful to rule out differential diagnoses.There is no established curative treatment, and therapeutic options yield variable responses.We report the case of an 88-year-old woman with a five-year history of progressively spreading, mildly pruritic annular purpuric lesions, initially affecting the lower extremities and subsequently involving the trunk and upper extremities.Treatment prior to our outpatient visit consisted of corticosteroids, phototherapy, and antibiotics, which proved ineffective.Examination revealed annular erythematousviolaceous, non-blanching macules and patches with central clearing and residual hyperpigmentation.Histopathology demonstrated a superficial perivascular lymphocytic infiltrate, vascular dilation, and erythrocyte extravasation, consistent with pigmented purpuric dermatosis.Dermoscopy revealed coppery pigmentation, supporting the diagnosis of purpura annularis telangiectodes of Majocchi.The atypical lateonset and near-generalized distribution prompted consideration of important mimickers, which were excluded histopathologically.The cornerstone of treatment was the initiation of colchicine; in addition, the use of adjuvant therapies, such as ascorbic acid, compression stockings, and emollients, led to a marked improvement in the lesions and pruritus after three months.This case highlights the importance of recognizing atypical presentations of this chronic, benign condition and avoiding unnecessary immunosuppressive therapy.