Hemorrhage into the skin takes many forms in structure, shape, and color. What we generally designate as purpura are macular lesions that may be punctate (petechial) or diffuse and red purple in color (ecchymotic). The causes are numerous. Most common among the benign pigmented purpuras is Schamberg's disease, a disorder of unknown etiology. Affected children have numerous discrete patches of petechiae on the lower extremities (Figs. 13-22 and 13-23). The individual lesions evolve into typical brown-orange macules containing “cayenne pepper” spots. Fresh petechiae occur at other sites. More significant causes of purpura include septicemia (see Figs. 15-36, 15-37, 15-38, 15-39), a wide variety of hematologic disorders, and vasculitis. Palpable purpura is, in fact, the hallmark of leukocytoclastic vasculitis, which may be a manifestation of bacterial or viral infection, drug allergy, connective tissue disease, or cryoglobulinemia. Henoch-Schönlein purpura, a common cause of childhood leukocytoclastic vasculitis, is discussed in Figs. 13-30, 13-31, 13-32.