AJ Journal of Medical Sciences

TO THE EDITOR

A 7-year-old girl presented to the OPD with one day history of reddish discoloration over her upper lip. She was otherwise healthy without any relevant skin or systemic diseases and had no significant family history. On initial questioning, there was no history of trauma, and the mother did not recall any precipitating event. However, she reported that the lesion had appeared approximately 15–20 minutes after the child consumed chocolate milk.

Examination revealed a well circumscribed, non-blanchable purpuric lesion  encircling the upper lip ([Fig. 1]). Dermoscopy revealed homogenous erythema with an irregular purpuric pattern ([Fig. 2]). “A similar dermoscopic evaluation has previously been reported in a case of facial suction purpura^[2]. In light of cutaneous findings, upon further questioning, the mother subsequently mentioned that the child consumed milk from a bottle and the child confirmed to have sucked the bottle for a prolonged period, leading to diagnosis of suction purpura. The lesion completely subsided in one week ([Fig. 3]).

Suction purpura is an important diagnostic consideration in children presenting with a localized, well-demarcated purpuric lesion over the perioral region. In the absence of an initially volunteered history of suction or trauma, the clinical appearance may prompt consideration of other causes of purpura. In our case, the temporal association with chocolate milk initially appeared noteworthy; however, detailed questioning regarding the method of consumption revealed prolonged bottle sucking as the likely precipitating factor.

The characteristic perioral distribution, together with the history of prolonged sucking, helped establish the diagnosis and avoided the need for further evaluation. The spontaneous resolution within one week further supported the benign nature of the condition.

This case emphasizes the importance of careful history taking in children with localized purpura. Specifically, enquiring about bottle feeding, prolonged sucking, and other forms of local mechanical trauma may help identify suction purpura and prevent unnecessary investigations and parental anxiety^{[1, 2]}.

Fig. 1: A well circumscribed, non-blanchable purpuric lesion localized to the perioral region, specifically encircling the upper lip

Fig. 2: Dermoscopy revealing homogenous erythema with an irregular purpuric pattern

Fig. 3: Complete resolution of the lesion

DISCLOSURE

Conflict of Interest: None.

Funding: Nil.