Pigmented Purpuric Dermatoses: Vitamin C and/or Rutoside or Watchful Waiting?

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Is there an advantage to treating children who have pigmented purpuric dermatoses with vitamin C and rutoside vs watchful waiting?

Treatment of pigmented purpuric dermatoses (PPD) with vitamin C and rutoside is well tolerated but does not appear to be an advantage over watchful waiting without therapy, according to study research published in Journal of the European Academy of Dermatology and Venereology.

The retrospective review evaluated the course and outcome of a cohort of children with PPD treated in a large pediatric dermatology practice in Chicago from 2008 to 2018, comparing off-label treatment with vitamin C and/or rutoside with watchful waiting. A total of 101 patients (girls, 57.4%; median age at diagnosis, 8.8 years) were evaluated. Median follow-up time was 7.13 months. The primary outcome was defined as complete response (CR), partial response, and no response. More than half (52%) of patients had evaluable follow-up documentation which were obtained by either their medical record or telephone interviews.

The most common PPD subtypes were lichen aureus (43%) and Schamberg disease (34%). Disease distribution varied in the PPD subtypes; lichen aureus was localized to a limited body area in 95.5% of the patients while Schamberg disease was distributed diffusely in 60% of the patients. In total, 53% of patients were treated with vitamin C and/or rutoside, and 47% of patients received no treatment. CR was documented in 45.3% patients overall including 42% patients in the treated group (vitamin C or rutoside or both), and 58% patients in the non-treated group. Median time to clearing in the entire cohort was 8.4 months (95% CI, 6.1-33.9), yet the difference in median time to clearance between the groups was not statistically significant (log rank P-value = .984). Recurrence was noted in 13.2% patients, however treatment status was not significantly associated with recurrence (P =.10). Treatment with vitamin C and/or rutoside was well tolerated without side effects.

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Limitations of the study include measured and unmeasured confounding due to the small sample size and retrospective approach.

The researchers concluded that although treatment with vitamin C and rutoside is well tolerated, they could not confirm “the efficacy of treatment with vitamin C and/or rutoside when compared with a watchful waiting approach. “

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Ollech A, Paller AS, Kruse L, et al. Pigmented purpuric dermatosis in children: A retrospective cohort with emphasis on treatment and outcomes (published online April 1, 2020). J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16397