Capillaritis, also known as pigmented purpuric dermatoses (PPD), is a group of skin conditions affecting tiny blood vessels called capillaries. It causes reddish-brown spots and patches on the skin. While generally harmless, capillaritis can be persistent and may cause cosmetic concerns. This has led to interest in various potential treatments, including Vitamin C.
Understanding Capillaritis
Capillaritis appears as distinctive reddish-brown dots and patches on the skin, often resembling “cayenne pepper spots.” While frequently observed on the lower legs and ankles, it can also develop on other body parts, including the thighs, buttocks, trunk, and arms.
This condition is considered benign, meaning it is not dangerous or contagious. However, it can be chronic and persistent, sometimes lasting for months or even years, though spontaneous resolution can occur. The discoloration arises from the leakage of red blood cells from fragile capillaries into the surrounding skin, followed by the breakdown of these cells and the deposition of iron-containing pigment called hemosiderin.
The precise cause of capillaritis is frequently unknown, a term referred to as idiopathic. However, several theories propose potential contributing factors. These include increased fragility of the capillaries, immune system reactions that lead to inflammation, and the involvement of reactive oxygen species, which can damage the endothelial barrier of blood vessels. Gravitational dependency, where blood pools in the lower limbs, is also considered a cofactor that can influence the condition’s presentation.
Vitamin C and Bioflavonoids for Capillaritis
Vitamin C (ascorbic acid) is considered for capillaritis because it plays a role in collagen synthesis. This is important for maintaining the structural integrity and strength of blood vessel walls, helping to reduce capillary permeability and lessen the leakage of red blood cells into the skin.
Vitamin C also functions as a potent antioxidant, helping to neutralize reactive oxygen species that can contribute to inflammation and damage within the blood vessels. When combined with bioflavonoids, such as rutoside (rutin), the therapeutic effect is believed to be enhanced. Bioflavonoids are thought to improve Vitamin C’s absorption and further strengthen capillary walls, reducing their permeability.
Studies have explored the efficacy of this combination. An open pilot study involving three patients with chronic progressive pigmented purpura showed oral rutoside (50 mg twice daily) and ascorbic acid (500 mg twice daily) led to complete clearance of skin lesions within four weeks. Another study reported significant improvement or complete clearance in 71.4% of 35 participants treated with rutoside and ascorbic acid, with a mean response rate of 7.9 weeks and a mean treatment duration of 8.2 months. These dosages (500 mg of ascorbic acid twice daily and 50 mg of rutoside twice daily) are general guidelines, and personalized medical advice is always recommended.
Other Management Approaches and Triggers
Capillaritis can be resistant to treatment, and a comprehensive approach or simple observation may be necessary. While no single medical intervention has consistently demonstrated benefit, some conventional options are considered. These include topical corticosteroids, which may help alleviate itching, and topical calcineurin inhibitors like pimecrolimus and tacrolimus, which offer a better side effect profile than steroids for certain types of capillaritis.
Phototherapy, such as narrowband ultraviolet B (UVB-NB) or psoralen plus UVA (PUVA), has also shown effectiveness in some patients, though recurrence after treatment is possible. In cases where venous stasis contributes to the condition, compression stockings can be beneficial in preventing blood leakage from capillaries, particularly in the lower legs.
Several factors can trigger or aggravate capillaritis. These include certain medications, such as aspirin, diuretics, thiamine, calcium channel blockers, and some anti-epileptic drugs. Chronic infections, prolonged standing, and intense exercise can also play a role. Additionally, contact allergies, for example to certain dyes, have been linked to capillaritis. Given the varied nature of triggers and potential for persistence, consulting a healthcare professional for an accurate diagnosis and tailored treatment plan is advisable.