Cutaneous vascularitis

Cutaneous Vasculitis

Cutaneous vasculitis is a condition characterized by inflammation of the blood vessels in the skin. This inflammation can lead to a variety of symptoms, including rash, skin lesions, and ulcers. Cutaneous vasculitis can occur as a primary condition or as a secondary manifestation of systemic vasculitis or other underlying diseases.

Pathophysiology

The pathophysiology of cutaneous vasculitis involves the inflammation of small to medium-sized blood vessels in the skin. This inflammation is often due to immune complex deposition, which triggers a cascade of inflammatory responses. The immune complexes can activate the complement system, leading to the recruitment of neutrophils and other inflammatory cells, resulting in vessel wall damage and increased vascular permeability.

Clinical Presentation

Patients with cutaneous vasculitis typically present with palpable purpura, which are raised, reddish-purple spots on the skin. These lesions are most commonly found on the lower extremities but can occur anywhere on the body. Other skin manifestations may include:

• Urticarial lesions
• Nodules
• Ulcers
• Livedo reticularis

Systemic symptoms such as fever, arthralgia, and malaise may accompany the skin findings, especially if the vasculitis is part of a systemic process.

Diagnosis

The diagnosis of cutaneous vasculitis is primarily clinical, supported by histopathological examination of a skin biopsy. The biopsy typically shows leukocytoclastic vasculitis, characterized by neutrophilic infiltration and fibrinoid necrosis of the vessel walls. Additional laboratory tests may be conducted to identify underlying causes or associated systemic diseases, including:

• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR)
• C-reactive protein (CRP)
• Antinuclear antibody (ANA)
• Antineutrophil cytoplasmic antibodies (ANCA)

Treatment

Treatment of cutaneous vasculitis depends on the severity of the condition and the presence of any underlying diseases. Mild cases may resolve spontaneously or with supportive care, such as rest and elevation of affected limbs. More severe cases may require pharmacological intervention, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Immunosuppressive agents (e.g., azathioprine, methotrexate)

In cases where an underlying cause is identified, treatment should also focus on managing the primary condition.

Prognosis

The prognosis of cutaneous vasculitis varies depending on the underlying cause and the extent of systemic involvement. Isolated cutaneous vasculitis often has a good prognosis with appropriate treatment, while systemic vasculitis may require long-term management and carries a more variable prognosis.

Also see

• Vasculitis
• Leukocytoclastic vasculitis
• Systemic lupus erythematosus
• Rheumatoid arthritis