Vasculitis and Vasculitic-like skin disorders Flashcards
Both Result in some reddish and/or purplish change in skin color
Vasculitis
pigmented purpuric lesions
!!! Changes not confined just to skin, but are often a manifestation of systemic disease
Lesions have a predilection for
leg
Very painful, bilateral and symmetrical
Progression of lesions
palpable purpura, usually!
Realize that the purpura can be palpable or non-palpable!!!!!!!!!!!
Classification Based on Size of Artery
- capillary-leukocytoclastic vasculitis (LCV) and Henoch-Schoenlein purpura
- small artery- granulomatous vasculitis, Henoch-Schoenlein purpura
a. Vast majority of vasculitis involves small arteries
b. Along with capillaries, most likely to have palpable purpura - medium artery-PAN (polyarteritis nodosa)
- large artery-giant cell arteritis
Major Etiologies of Purpura
“The Sleepy Giant’s Hen Cried With Pain”
-Thrombocytopenia and coagulopathies-nonpalpable If associated with sepsis, consider DIC Usually palpable -SLE -Giant cell arteritis -Henoch-Schonlein -purpura -Cryoglobulinemia -Wegener granulomatosis -PAN
Henoch-Schonlein Purpura (“IgA Vasculitis”)
Children and young adults
Preceded by pharyngitis
Usually Strep throat
Henoch-Schonlein Purpura (“IgA Vasculitis”) Diagnosis
A biopsy
Poly Arteritis Nodosa (PAN)
Necrotizing inflammation with common manifestation of nodules
Leads to ischemia or infarction of gut, heart, kidney
Association with hepatitis B
Diagnosis confirmed by arterial aneurysms on angiography of renal, hepatic, splanchnic, or splenic circulations
PAN Diagnosis
New onset diastolic BP >90mmHg
A biopsy
Wegener’s Granulomatosis
- Primarily affects lungs and kidneys
- Has both granulomas and vasculitis
- Causes nail fold infarcts and purpura
Wegener’s Granulomatosis Diagnosis
Nasal or oral inflammation (painful or painless oral ulcers or purulent or bloody nasal discharge)
Abnormal chest radiograph showing nodules, fixed infiltrates, or cavities
Abnormal urinary sediment (microscopic hematuria or red cell casts)
antineutrophil cytoplasmic antibodies (ANCA)
A biopsy
Giant Cell Arteritis
Most common type of primary systemic vasculitis
Age ≥ 50 years at time of disease onset
Localized headache of new onset
Giant Cell Arteritis Diagnosis
Erythrocyte sedimentation rate (ESR) greater than 50 mm/h (Westergren)
Biopsy
