Purpura fulminans is a catastrophic disease of childhood characterized by the sudden appearance of symmetrical, tender, ecchymotic skin lesions usually involving the lower extremities. The lesions rapidly increase in size, necrose, and result in a high morbidity and mortality. This communication reviews five cases of purpura fulminans diagnosed and treated at the Childrens Hospital of Los Angeles. Laboratory studies confirmed that disseminated intravascular coagulation is a major component of the disease and early treatment should be directed at control of this process. Intensive supportive therapy and intravenous administration of heparin sodium are indicated at the time of diagnosis. The rationale for heparin therapy, its dosage, duration of treatment, and its limitations are reviewed in relation to the five patients, two of whom died. Hyperbaric oxygen therapy was utilized in two patients and resulted in transient clinical improvement. Corticosteroid therapy used in two patients did not appear to influence the course of the disease. The use of dextran (Dextran 6%) had no apparent effect in one patient. All three survivors required extensive skin grafting and two required amputation of one or more extremities.