Auspitz sign describes pinpoint bleeding on the skin after dry scales are scraped away. It is not a commonly used term. However, it is sometimes affects people with psoriasis and those with other skin conditions such as actinic keratoses and Darier disease.

The Auspitz sign was named after the Austrian dermatologist Heinrich Auspitz (1835–1886). However, Ferdinand von Hebra and Marie Devergie first noted the small hemorrhages under psoriasis scales.

It occurs when small blood vessels underneath the surface of the skin rupture, leading to small spots of blood. These can be red in people with lighter skin, and they may appear purple or black in people with darker skin. Typically, the spots occur when a person scrapes at a scaly rash.

An Auspitz sign itself is not harmful. However, it can indicate a person has an underlying condition causing it, such as psoriasis.

This article explains what an Auspitz sign is, why it happens, and how it is treated.

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The Auspitz sign refers to the pinpoint bleeding seen after scales are scraped off. It is not sensitive and can occur in people with psoriasis and other skin conditions.

It happens because the skin under the scales is thin, making it prone to damage. The underlying capillaries are particularly exposed, and when scratched, they can break.

In people with lighter skin, the scales usually appear white or silvery, and the pinprick blood spots are red.

However, in people with darker skin, the scales can be purplish, brown, or grayish in color. They are also more prone to psoriasis hyperpigmentation, making it harder to identify an Auspitz sign.

Although doctors often associate the Auspitz sign with psoriasis, it can also happen with skin conditions such as actinic keratoses and Darier disease.

Actinic keratosis is a precancerous skin condition. The keratoses tend to appear in sun-damaged areas, and long-term exposure to ultraviolet rays increases a person’s risk.

Conversely, Darier disease is a rare genetic disorder that causes odorous, wart-like growths on the body. They are primarily found in the following areas:

  • forehead
  • scalp
  • upper arms
  • chest
  • back
  • knees
  • elbows
  • behind the ears

Additionally, they can appear on the palms of the hands, soles of the feet, and nails.

Psoriasis is a chronic immune-mediated inflammatory skin condition that causes rapid cell turnover. This means new skin cells grow too quickly, creating thick, itchy, scaly plaques.

Under the layer of scales, the skin can be very thin and fragile. When people scratch itchy patches of skin, they can damage the thin skin beneath. This can cause inflamed capillary blood vessels or ruptured blood vessels.

The Auspitz sign causes pinpoint bleeding or blood spots. An individual may notice dried blood on the surface, and psoriasis scales may surround the area.

Some people may experience itching, pain, or irritation.

A doctor might use the Auspitz sign to diagnose psoriasis. They can do this by scraping off the thick scales of psoriatic plaque. They may need to use specialized tools, such as a dermascope, to magnify the area.

Although the appearance of the Auspitz sign may suggest psoriasis, however, it can also occur in actinic keratoses, or Darier disease. It is not always seen in psoriasis, so it is not a common method of diagnosis.

A trained healthcare professional can often diagnose skin conditions by clinically examining the skin and taking a full medical history.

Psoriasis

Diagnosing psoriasis involves a physical examination of the skin, nails, and scalp.

A doctor may discuss a person’s medical history, symptoms, and family history. They might also take a biopsy, or skin sample, to examine and test the skin.

Learn more about psoriasis.

Actinic keratosis

A doctor will use similar techniques to diagnose actinic keratosis.

First, they will examine the skin and ask questions about an individual’s health and symptoms. They may also examine the skin for signs of skin cancer, as people who develop actinic keratosis have a higher risk of skin cancer.

Learn more about actinic keratosis.

Darier disease

Because Darier disease is genetic, people usually have a family member with the condition. Therefore, doctors diagnose it from family history and the appearance of the skin.

They may use genetic testing to look for mutations in the ATP2A2 gene to confirm their diagnosis. Additionally, doctors usually perform a skin biopsy to diagnose Darier’s disease.

If a person has an Auspitz sign, a doctor will treat the underlying condition causing it.

Psoriasis

If a person’s psoriasis is limited to the skin and does not affect a large area, a doctor may prescribe topical treatments, such as:

Moderate to severe psoriasis may require systemic treatments such as methotrexate or cyclosporine.

If an individual has no success with psoriasis treatment and the condition is severe, doctors may recommend injections of biologics such as Humira (adalimumab) or Enbrel (etanercept).

Learn more about treatment for psoriasis.

Actinic keratosis

Treatment for actinic keratosis may involve:

  • Cryosurgery: This technique involves freezing the affected areas so they fall off.
  • Chemical peels: These treatments destroy the top layer of skin. As the area heals, new skin will grow in its place.
  • Curettage: This procedure scrapes the affected areas and uses heat to destroy any remaining cells.
  • Photodynamic therapy: This treatment involves the application of a topical medication prior to treating the area under a light. This is usually used to treat multiple Actinic keratoses.

Learn more about treatment for actinic keratosis.

Darier disease

Treatment for Darier disease may include:

  • avoiding the sun and hot environments
  • using moisturizers with urea or lactic acid
  • applying topical medications such as retinoids
  • taking oral antibiotics to clear any bacterial infections

An individual’s outlook depends on the underlying condition causing their Auspitz sign.

There are no cures for psoriasis or Darier disease. However, treatments can help improve their symptoms.

In actinic keratosis, treatment can often eliminate the condition. However, in rare cases, a person may develop skin cancer. People with actinic keratoses symptoms should contact a doctor to seek immediate treatment.

Auspitz sign refers to pinpoint bleeding under the skin’s surface. It typically occurs after scratching psoriasis plaques or other forms of skin scales.

Although the Auspitz sign may indicate that an individual has psoriasis, actinic keratoses, or Darier disease, it is not a clear marker of diagnosis.

A doctor will evaluate a person’s symptoms and decide on a treatment plan that addresses the underlying cause of the Auspitz sign if it is used as a diagnostic tool.