New Onset of Linear Purpura on the Back: Coining Therapy-Associated Ecchymoses

Coining therapy is a treatment commonly used in complementary and alternative medicine. The practice has its origins in several different Asian countries. It is used to treat numerous conditions, such as chronic pain, fever, flu, headaches, heatstroke, and upper respiratory infections. Coining is performed by vigorously rubbing a rounded instrument following the application of lubricant to the affected area. Hence, patients who have undergone coining therapy frequently present with macular erythema, petechiae, and/or raised ecchymoses at the sites of treatment. The cutaneous sequelae following treatment with coining on a Vietnamese man are described. Ecchymoses caused by coining usually resolve spontaneously within one to two weeks. While coining is generally regarded as a safe practice, mild or - albeit rarely - more severe complications may occur. Therefore, this procedure is contraindicated in certain patients including those with bleeding disorders, Von Willebrand disease, or those taking antiplatelet or anticoagulant medications. Several randomized-control studies suggest coining to be an effective treatment for chronic neck and lower back pain. Immediate pain relief at the treated site may result from increased circulation; thus, the venting of heat may mitigate the effects of the inflammation and pain. However, much remains to be learned about the mechanisms of longer-term pain relief in coining therapy. The use of complementary and alternative medicine techniques such as coining has increased in the United States; therefore, clinicians’ evaluation and management of their patients would benefit from an understanding of the individual’s sociocultural practices and health beliefs.