Angiitis (vasculitis) of the skin

Angiitis (vasculitis) of the skin is a group of inflammatory-allergic dermatoses, the main manifestation of which is the defeat of dermogipodermal blood vessels of different calibres.

The etiology is unknown.

Pathogenesis in most cases is immunocomplex (damage to vascular walls by immune deposits with infectious, medicamentous and other antigens). The main importance is attached to the focal (less common) chronic infection (streptococci, staphylococcus, tubercle bacillus, yeast and other fungi), which can be localized in any organ (more often in tonsils, teeth). The chronic intoxications (alcoholism, smoking), endocrinopathies (diabetes mellitus), metabolic disorders (obesity), hypothermia, general and local vascular diseases (hypertension, obliterating thromboangiitis), diffuse connective tissue diseases have definite significance in the development of angiitis.

Distinctive common signs of skin angiitis: inflammatory-allergic nature of rashes with a tendency to edema, hemorrhages and necrosis; Polymorphism of vysypnyh elements; Symmetry of rashes; Preferential or primary localization on the lower limbs; Acute or periodically exacerbating current; Frequent presence of concomitant vascular or allergic diseases of other organs.

Clinical picture. Depending on the caliber of the affected vessels, deep (hypodermal) angiitis is distinguished, in which arteries and veins of the muscular type are affected (nodular periarteritis, nodular angiitis), and superficial (dermal), caused by defeat of arterioles, venules and capillaries of the skin (polymorphic dermal angiitis, chronic pigmentary purpura). About 5.0 clinical forms of skin angiitis have been described.

Nodular periarteritis (cutaneous form). The most characteristic are a few, the size of a pea to walnut, nodular rashes that appear paroxysmal along the vessels of the lower extremities. The skin above them can later become bluish-pink. Eruptions are painful, can ulcerate, there are several weeks or months.

Nodular angiitis, see Nodular erythema.

Polymorphic dermal angiitis (Guzero-Ryuiter disease) has several clinical types: urticar (persistent blisters), hemorrhagic (identical to hemorrhagic vasculitis, manifested primarily by hemorrhagic rash in the form of petechiae, purpura, ecchymoses, blisters with subsequent erosion or ulceration), papulonecrotic (inflammatory Nodules with central necrosis leaving depressed scars), pustular-ulcerative (identical to gangrenous pyoderma), necrotic ulcer (formation of hemorrhagic necroses with transformation into ulcers), polymorphous (combination of blisters, nodules, purpura and other elements).

Chronic pigment purpura (progressive pigment purple of Shamberg, hemosiderosis of the skin) is manifested by repeated multiple petechiae with an outcome in brownish-brown spots of hemosiderosis.

Diagnosis of skin angiitis is based on a characteristic clinical symptomatology. In difficult cases, a pathohistological examination is performed. It is usually necessary and with a differential diagnosis with tuberculous lesions of the skin (inducible erythema and papulonecrotic tuberculosis). This takes into account the young age of patients with cutaneous tuberculosis, winter exacerbations of the process, positive skin tests with diluted tuberculin, the presence of tuberculosis of other organs.

Treatment. Sanitation of foci of infection. Correction of endocrine-metabolic disorders. Antihistamines, vitamins (C, P, B15), calcium preparations, non-steroidal anti-inflammatory drugs (indomethacin, butadione). With a clear connection with the infection - antibiotics. In severe cases - hemosorption, plasmapheresis, long-term corticosteroids in adequate doses with a gradual cancellation. In chronic forms - quinolines (delagil 1 tablet a day for several months). Locally with spotty, papular and nodular rashes - occlusive bandages with corticosteroid ointments (fluxin, fluorocort), liniment "Dibunol"; With necrotic and ulcerative lesions - spoon with schimopsin, ointment "Iruksol", ointment Vishnevsky, ointment "Solcoseryl", 10% methyluracil ointment. In severe cases, bed rest, hospitalization is necessary.

The prognosis for isolated skin lesions is favorable for life, for a complete cure is often questionable.

Relapse prevention. Sanction of focal infection; Avoid prolonged pressure on the legs, hypothermia, bruises of the legs. Sometimes employment is required.