Capillaritis (also known as benign pigmented purpura and pigmented purpuric dermatosis [PPD]) is a dermatologic condition resulting from inflammation and disruption of papillary dermal vessels, with subsequent extravasation of red blood cells. The subtypes of capillaritis differ in both demographics and clinical presentation, with overlap noted. Lesions are characterized by cayenne-pepper-like petechiae, purpura, and golden-brown pigmentation. While classically macular, with more intense inflammation, papular lichenoid or eczematous changes may also be exhibited.

Capillaritis in its most common form is typically asymptomatic, but in some types, it may be pruritic, mildly painful, or may burn. It is usually chronic with intermittent exacerbations and remissions. There is no geographic or hereditary predilection. Atypical presentations of capillaritis not consistent with the following classification should raise the suspicion of some other underlying condition.

The well-described PPDs are:

Classic forms

• Schamberg disease – the most common manifestation of PPD; affects middle-aged to older men
• Purpura annularis telangiectodes (Majocchi disease) – uncommon; affects adolescents to young adults; most common in females
• Eczematid-like purpura of Doucas and Kapetanakis – a more inflammatory and less common subtype of Schamberg disease
• Pigmented purpuric lichenoid dermatosis of Gougerot and Blum – rare; most common in middle-aged men
• Lichen aureus – most common in young men

Other forms

• Linear pigmented purpura – uncommon; most commonly affects children and adolescents
• Granulomatous pigmented purpura – very rare; most common in middle-aged to older adults and Asian individuals
• Golfer's vasculitis (exercise-induced vasculitis; hiker's rash) – relatively common but underrecognized. Lower leg PPD associated with prolonged walking or hiking in hot and humid conditions. Seen mostly in people aged 50 years and older. It typically spares the compression band area of socks and resolves over a few days without treatment.

Development or worsening of preexisting capillaritis has been associated with venous hypertension, increased capillary fragility, gravity, exercise, and focal infections. Alcohol use disorder, especially with associated liver damage, appears to be an additional risk factor for Schamberg disease. There has been at least one case of Majocchi pigmented purpura following sclerotherapy treatment of the legs. Capillaritis has also been reported as a rare sequela of SARS-CoV-2 vaccination, both primary and booster.