Suction purpura over the chest at the precordial chest leads to electrocardiogram

A 28-year-old male presented with ring-shaped purpuric lesions over the upper left chest following an electrocardiogram (ECG). The patterned lesions correspond to the site of ECG leads. Cutaneous examination revealed well-defined petechial purpuric rashes over the chest in a distribution typical of precordial chest leads [Figure 1]. There was no history of itching, pain, or bleeding. Allergic contact dermatitis can be caused by ECG gels or pastes, alcohols found on prepacked gauzes, rubber or metal electrodes, and pads used as a substitute for ECG paste. As there was no significant itching or personal history of allergic reactions, the possibility of allergic contact dermatitis to ECG leads was not considered, and a patch test was also not performed. Complete hemogram, coagulation profile, and platelet count were within normal limits. A clinical diagnosis of purpuric lesions secondary to ECG chest leads suction balls was made.

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Figure 1:

Well-defined circumscribed purpuric skin lesions over the chest corresponding to the precordial V1–V6 chest leads.

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Suction purpura results from an external source exerting a negative pressure on a circumscribed skin area, producing small grouped petechiae. It is limited to the site of increased negative pressure. It can be caused by ECG leads, therapeutic cups, vacuum extractors, hickeys, gas masks, and neurotic suctions. Suction purpuric lesions make us rule out any underlying hematological disorder. Purpuric lesions secondary to suction do not need any extensive workup or treatment.

The lesions disappear within a few weeks without any treatment.^[1] There are no such observations published in the available literature and hence the reporting of the image to alert physicians and ECG technicians.