CUTANEOUS VASCULITIDES AND CUTANEOUS MANIFESTATIONS OF SYSTEMIC VASCULITIDES

Abstract

Background Cutaneous vasculitis may be limited to the skin or may appear as part of systemic vasculitides. The type and intensity of changes depend on vessel size and the severity of involvement. The most common manifestation of small vesel vasculitis is palpable purpura, while vasculitis of medium-sized and large vessels usually express as livide noduses and ulcers. Cutaneous vasculitis may also manifest as bruises, erythema multiforme, papules, pustules, livedo and vesiculo-bullous lesions. The diagnostic procedure, in addition to clinical and laboratory investigations, frequently includes skin biopsy. Evaluation of tissue specimen includes standard histological examination of formalin fixed tissue and direct immunofluorescence of non-fixed fresh samples. The commonest histologic type of skin vasculitis is leukocytoclastic, which involves venules and capillaries and is a consequence of deposition of immune com plexes with complement activation. Typical representatives are Henoch-Schönlein purpura, cryoglobulinemic vasculitis and vasculitis in systemic lupus erythematosus. Necrotizing arteriolitis and arteritis of small arteries are usually found in ANCA positive vasculitides. Medium-sized arteries can be involved in both ANCA positive vasculitides and polyarteritis nodosa. Conclusions This article presents the clinical picture, histopathologic characteristics, pathogenetic mechanisms and treatment of some clinicopathologic entities of vasculitides, such as Henoch-Schönlein purpura, urticarial vasculitis, cryoglobulinemic vasculitis, microscopic polyangiitis, Wegener\'s granulomatosis, Churg-Strauss syndrome and polyarteritis nodosa.