Allergic vasculitis of the skin: causes and photos
Allergic vasculitis of skin – a heterogeneous group of diseases characterized by damage to small blood vessels of the skin. There are such varieties of violations, allergic vasculitis of the skin, lakokrasochnyi vasculitis and vasculitis with predominant skin lesions.
Until now, scientists did not come to the same conclusion at the expense of the mechanism of development, since this antigen is almost never you cannot find.
On the other hand other forms of vasculitis will likely also associated with allergic manifestations, but to antigens that have not yet installed.
The constant debate is exposed and the term "lakokrasochnyi vasculitis". The fact that not all vasculitis this group are accompanied by leucoclada.
More successful could be termed "vasculitis, mainly affecting the skin, since this vasculitis, in addition to possible skin lesions affecting other organs. However, they may not be as heavy as in the case of systemic vasculitis.
Epidemiology of allergic vasculitis of the skin
Allergic vasculitis of the skin suffer more often than systemic vasculitis. It is known that the first affects women and men of any age. At risk of other types of diseases are people of a certain gender and age.
Pathological anatomy and pathogenesis of allergic vasculitis of the skin
In case of allergic vasculitis of the skin start to change small vessels, as a rule, post-capillary venules. Sometimes affects the arterioles and capillaries.
In addition, the recorded infiltration of the vascular walls and other neutrophils. The decomposition of neutrophils, and the formation of nuclear dust, this phenomenon is called leucoclada.
In the later stages of allergic vasculitis of the skin, infiltration predominate lymphocytes, some types of disease is characterized by the eosinophils. You may receive an diabetes of red blood cells, which will cause palpable purpura.
Pathogenetic mechanism of development of allergic vasculitis –deposition of immune complexes. Still, for all the vasculitis group, it has not been proven.
Doctors distinguish 2 subgroups of allergic vasculitis, depending on the antigen, which is:
- Allergic vasculitis is caused by exogenous antigens. Example: when vasculitis essential mixed cryoglobulinemia antigen is the hepatitis C.
- Allergic vasculitis is caused by endogenous antigens. Example: vasculitis in SLE have as an antigen, DNA, rheumatoid arthritis as antigen — antibody. Antigen paraneoplastic vasculitis is a group of tumor antigens.
In addition, in some forms of lymphoproliferative disorders mayto begin the elaboration of cytokines that are directly involved in the development of vasculitis.
Laboratory data and clinical picture
The main symptoms of allergic vasculitis associated with skin lesions. There is palpable purpura, there are also vesicles, spots, papules, blisters, ulcers, subcutaneous nodes, and chronic urticaria.
In varying degrees of severity in the process can participate internal organs, which helps to deliver a more accurate diagnosis.
In the case of an isolated lesion of the skin will cause General symptoms – malaise, fever, loss of appetite or myalgia.
Often the rash is accompanied by burning, itching and measurable pain. Rash usually appears where pronounced hydrostatic pressure in post-capillary venules. Patients who go is the legs, those who do not go — sacral region.
Sometimes a rash develops along with edema. In case of prolonged and recurrent course of illness can appear the hyperpigmentation of the skin.
Laboratory parameters and their changes in case of allergic vasculitis of the skin – non-specific. Characteristic leukocytosis moderate, erythrocyte sedimentation rate, and in rare cases, eosinophilia. Sometimes detect rheumatoid factor and cryoglobulin.
Drug vasculitis. He is one of the species of medicinal drug reaction.
Length of medicinal characteristic of vasculitis palpable purpura on the whole body or in the sacral region, legs. In addition, there may be ulcers, blisters or bubbles with hemorrhagic content.
For medicinal vasculitis is characterized by such symptoms as arthralgia, malaise and fever. Drug vasculitis can cause gold drugs, allopurinol, phenytoin, thiazide diuretics, sulfonamides, penicillins.
Serum sickness. For diseases characterized by urticaria, fever, arthralgia and lymph node enlargement in approximately 7-10 days after the first, and after 2-4 days after the re-introduction of non-protein substances or foreign protein. We are talking about the penicillin.
The manifestations of serum sickness are not associated with vasculitis, but some patients recorded typical vasculitis and lesions venules of the skin, sometimes affects the structure of the blood vessels of internal organs.
Secondary vasculitis. Characteristic of rheumatic diseases, such as Sjogren's syndrome, rheumatoid arthritis or SLE.
Vasculitis often manifests the venules of the skin. The clinical picture is similar to allergic vasculitis of the skin, caused by an exogenous antigen. But some people have formed a systemic necrotizing vasculitis with lightning current.
Cryoglobulinemia occurs when different forms of vasculitis. When vasculitis essential mixedcryoglobulinemia to start the development of skin lesions, but more often it is combined with arthralgia, lymph node enlargement, glomerulonephritis and hepatosplenomegaly.
Vasculitis can be a companion of some malignancies, for example lymphoproliferative diseases.
There are other causes of allergic vasculitis of the skin:
- Infective endocarditis;
- Primary biliary cirrhosis of the liver;
- HIV infection;
- Inter-intestinal anastomosis;
- Ulcerative colitis;
- Infectious mononucleosis;
- Chronic active hepatitis;
- Fibrosis of the retroperitoneal space;
- Congenital deficiency of components of complement;
- Deficiency of α1-antitrypsin;
- Recurrent polyhedric.
Diagnosis of allergic vasculitis of the skin
The diagnosis of allergic vasculitis confirmed by histology. In case of allergic vasculitis affects skin, like in the photo, so a biopsy is not very complicated. For the diagnosis of this disease is important for successful search causes.
The most important thing to find out: vasculitis caused by drug or exogenous microbial antigen or as a concomitant violation of the basic disease.
In order to exclude lesions of the internal organs in allergic vasculitis necessary to carry out instrumental and laboratory tests. You should start with non-invasive methods.
How to treat allergic vasculitis
A long period of treatment, accompanied by lesions of the internal organs, requires different ways of treatment of this disease. As a rule, the usual medication helps slightly, and allergic vasculitis continues to evolve.
Wegener's granulomatosis, and systemic necrotizing vasculitis are usually severe and can be treated only with prednisone and cyclophosphamide. In any case of allergic vasculitis has a favorable prognosis, because it affects, for the most part, the skin, as in the photo.
In case of determining the precise antigen, it must be removed immediately. If it's an infection, antimicrobial therapy is shown. Secondary allergic vasculitis usually goes away once cured the underlying disease, and an allergic reaction is no longer an issue.
If the healing process takes a long time and affected the internal organs, as it happens on the background of rheumatic disorders, the treatment will be similar systemic necrotic vasculitis. Assigned to glucocorticoids, it is important to quickly lower the dosage and stop the drug.
The ineffectiveness of glucocorticoids and high risk of total damage to internal organs, the doctor prescribes immunosuppressants. This may be a cyclophosphamide to the classical scheme of treatment.
Ifisolated lesions of the skin occurs for a long period of time, do not expect lightning improvement while taking any medication. You should know that to immunosuppressants should be the last resort, when other medications have been tried and proven ineffective.
With the rapid course of allergic vasculitis plasmapheresis may help together with the transfusion of donor plasma.