Rapid Clinical Improvement with Pentoxifylline in Pigmented Purpuric Dermatosis: A Case Report and UV-F Dermoscopy Findings

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Pigmented purpuric dermatoses (PPD) are chronic capillaritides characterized by petechiae, purpura, and brown macules.We present a biopsy-confirmed case of Schamberg disease with rapid clinical improvement following a 2-week course of oral pentoxifylline.A 25-year-old woman presented with an approximately 5-year history of recurrent asymptomatic petechial eruptions affecting the upper and lower extremities.Dermoscopy demonstrated reddish, round-to-oval globules and dots on a brownish background.Ultraviolet-induced fluorescence (UV-F) dermoscopy enhanced the visibility of active petechial foci and assisted in selecting an optimal biopsy site.Histopathology revealed a superficial perivascular lymphocytic infiltrate with focal erythrocyte extravasation and pigment-laden macrophages in the papillary dermis; features of leukocytoclastic vasculitis were absent.After failure of topical high-potency corticosteroids and topical calcineurin inhibitors, controlled-release pentoxifylline 600 mg once daily was initiated.Near-complete clinical resolution was observed by day 14.Treatment was discontinued because of nausea and vomiting, and remission persisted at 2-month follow-up.This case suggests that pentoxifylline may be associated with early clinical improvement in selected patients with PPD and highlights UV-F dermoscopy as a practical adjunct for identifying active purpuric foci and selecting a biopsy site.

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