Purple Bumps on the Beltline That Bleed: Differential Diagnosis

Small purple, bleeding papules along the waistband may represent:

• Spider veins (telangiectasias) – Dilated capillaries; bleed with minor trauma.
• Varicose veins – Larger, tortuous; can occur on abdomen.
• Cherry angiomas / hemangiomas – Benign vascular proliferations.
• Pyogenic granuloma – Rapidly growing, friable, vascular nodule.
• Inflammatory dermatoses – Eczema, psoriasis with excoriation.

Clinical exam ± dermatoscopy differentiates. Biopsy if uncertain. Treatment: observation, laser, excision, topical therapy per diagnosis.