Lichen aureus

Synonyms: Martin 1958

By Dr. Pascal Bafteh · last updated 09/2026

Definition & Classification

• Pigmented purpuric dermatoses (PPD; purpura pigmentosa progressiva, "capillaritides") = group of chronic, benign lymphocytic capillaritides with erythrocyte extravasation and hemosiderin deposition — not a true vasculitis (no fibrinoid vessel-wall necrosis).
• Hallmark: non-blanchable (diascopy negative) petechial "cayenne-pepper" dots + golden-brown/orange hemosiderin macules, preferentially on the lower legs/pretibial, usually symmetrical, course over months to years.
• Mostly affects older men; often asymptomatic or mildly itchy.

Pathophysiology — WHY the golden-brown color?

Cell-mediated (predominantly CD4⁺ T-cell) inflammation around the postcapillary venules/capillaries of the papillary dermis → endothelial swelling, increased vascular permeability and fragility → extravasation of erythrocytes into the corium (fresh lesion = bright red) → phagocytosis by macrophages → intracellular hemosiderin (Fe³⁺) in siderophages → golden-brown "aureus" hue (Perls/Prussian blue positive). There is no fibrinoid necrosis and leukocytoclasia — this is exactly what histologically separates PPD from leukocytoclastic vasculitis.

• Associations/triggers: venous hypertension/stasis, medications (including paracetamol, NSAIDs, diuretics, statins), infections, contact allergens, physical exertion.

Clinical Variants (Eponyms)

• Schamberg disease (purpura pigmentosa progressiva, Schamberg 1901) — most common form: cayenne-pepper petechiae on a brownish background, lower legs.
• Purpura annularis telangiectodes (Majocchi 1896) — annular/ring-shaped lesions with telangiectasias at the border and central clearing, occasionally mild atrophy.
• Lichenoid purpura (Gougerot-Blum 1925) — small lichenoid papules, purpuric, confluent.
• Eczematid-like purpura (Doucas-Kapetanakis 1953) — with scaling and marked pruritus.
• Lichen aureus (lichen purpuricus, Martin 1958) — usually solitary, golden-yellow to rust-brown group of lichenoid papules, often on the leg over a perforating vein, particularly persistent.

Differential diagnoses

• Schamberg's disease (progressive pigmented purpura)
• Purpura annularis telangiectodes (Majocchi disease)
• Pigmented purpuric lichenoid dermatosis of Gougerot-Blum
• Mycosis fungoides
• Leukocytoclastic vasculitis
• Kaposi's sarcoma

Sources (selection)

1. Plewig G, French L, Ruzicka T, Kaufmann R, Hertl M (Hrsg). Braun-Falcos Dermatologie, Venerologie und Allergologie. 7. Aufl. Berlin: Springer; 2018. S. 1252–1254.
2. Spigariolo CB, Giacalone S, Nazzaro G. Pigmented Purpuric Dermatoses: A Complete Narrative Review. J Clin Med. 2021;10(11):2283.
3. Tolaymat L, Hall MR. Pigmented Purpuric Dermatosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.

More vascular skin disorders

• Erythromelalgia
• Leukocytoclastic vasculitis
• Superficial thrombophlebitis
• Great saphenous vein varicosity
• Deep vein thrombosis

Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.