# A Case Report of Pigmented Purpuric Dermatosis With No Granuloma Formation: A 20‐year Follow‐Up Case Study

## TL;DR

A 20-year case of pigmented purpuric dermatosis showed no granuloma formation despite long-term pigmentation and hyperlipidemia.

## Contribution

The study highlights that granuloma absence may relate to histiocyte/phagocyte function, not disease duration or pigmentation.

## Key findings

- Oral ozone water cured the primary disease but not the pigmentation.
- Histological analysis showed no granuloma formation despite long-term pigmentation.
- Hyperlipidemia did not influence granuloma formation in this case.

## Abstract

In a case of pigmented purpuric dermatosis with hyperlipidemia reported earlier to be persistent for over 20 years, the primary disease was cured by oral rinsing with ozone water; however, the remaining prominent pigmentation was not remarkably improved even with oral administration of vitamin C and laser treatment. A histological examination of the lesion was performed to resolve the difficulty in removing this pigmentation. No granuloma reaction, including giant cells, was observed in the lesion tissue, even after such a long course and significant pigmentation. Granuloma formation in this disease may be a functional problem of the patient′s histiocytes and/or phagocytes rather than its chronic course or excessive hemosiderin deposition. Similarly, hyperlipidemia did not affect granuloma formation.