Overview
This disease, also known as cutaneous small vessel vasculitis and cutaneous leukocyte fragmentation vasculitis, is a kind of necrotizing vasculitis of unknown etiology mainly caused by small blood vessels of the skin, especially post-capillary microvessels, which is more common in women. Clinical manifestations include papules, palpable purpura, urticaria, and ulcers, mostly on the lower limbs, and patients are self-conscious of pain or itching. It may be accompanied by systemic symptoms such as fever, malaise and arthralgia.
Questions you may be concerned about
What is allergic cutaneous vasculitis?
Atopic cutaneous vasculitis, also known as cutaneous small vessel vasculitis, is a vasculitis that involves only the small blood vessels of the dermis.
The cause of the disease is unknown and may be related to infections, drugs, tumors, and chemicals. The pathogenesis is related to the deposition of endothelial immune complexes in small vessels. It occurs in the lower limbs and buttocks, especially in the calves. The main manifestations are symmetrically distributed polymorphic skin lesions, such as erythema, papules, purpura, blisters, blood blisters, ulcers, etc., or accompanied by fever, malaise, joint pain and other symptoms.
It is usually necessary to find and eliminate the suspected causative factors. Clinically, most allergic cutaneous small vessel vasculitis is self-limiting and only requires rest, supportive therapy and topical glucocorticoids such as mometasone furoate. For larger lesions, oral or intravenous glucocorticoids such as dexamethasone or cytotoxic drugs such as cyclophosphamide are required.
In addition, patients with allergic skin vasculitis are advised to quit smoking and drinking, and to eat a low-salt, low-fat, low-sugar diet. Moderate physical exercise, maintain a relaxed mood, more conducive to the recovery of the disease. If you suspect allergic skin vasculitis, it is recommended to go to the hospital in time to avoid delaying the condition, the above drugs need to be used under the guidance of a doctor.
Causes
It may be related to bacterial toxins, viral infections, foreign proteins and certain drugs. Sensitizing substances enter the body as antigens, combine with antibodies to form immune complexes, and deposit on the vessel wall causing vascular damage.
Symptoms
Prevalent in young women, usually acute onset, often involving the ankles or lower legs, manifested as palpable purpura, erythema, papules, blisters, urticaria, pustules, etc., the rash size varies, some patients feel pain, burning or itching, the rash can be relieved in a few weeks or months, and some patients may have recurrent episodes of chronicity, with a prognosis of hyperpigmented patches left behind. Patients may be accompanied by fever, weight loss, arthralgia, muscle pain and other systemic symptoms, some patients may have gastrointestinal tract involvement, loss of appetite, nausea, vomiting, may have urinary tract involvement, glomerulonephritis.
Examination
1. Laboratory tests may include increased blood eosinophils, accelerated blood sedimentation, decreased serum total complement, and hematuria and proteinuria in severe cases.
2. Histopathology typically shows leukocytoclastic vasculitis with segmental distribution centered on small vessels in the upper dermis. Endothelial swelling of small vessels, vascular occlusion, fibrin exudation, degeneration and necrosis of the vessel wall, erythrocyte spillage, infiltration of neutrophils in and around the vessel wall with nuclear fragmentation.
Diagnosis
1. Chronic, recurrent, mainly distributed on both lower limbs;
2. Rash with polymorphic damage such as erythema, papules, purpura, small blisters, nodules, wind clouds and ulcers;
3. Increased white blood cell count and rapid blood sedimentation;
4. Increased anti-“O” value;
5. Histopathology shows non-specific adipose tissue inflammation in the upper part of the subcutaneous tissue and inflammatory reaction in the dermis.
Treatment
1. General treatment, pay attention to rest, appropriate diet, avoid cold, elevate the patient, find and remove the possible causes.
2. For mild symptoms, oral antihistamines and non-steroidal anti-inflammatory drugs can be taken.
3. For severe symptoms with skin ulcers or systemic symptoms, oral glucocorticoids can be given; or oral immunosuppressants, such as cyclophosphamide.