Kutane Symptome der Vaskulitiden

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• 作者：Prof. Dr. C. Sunderk?tter ; K.I. Pappelbaum ; J. Ehrchen
• 关键词：Polyarteriitis nodosa ; Immunkomplexvaskulitis ; Leukozytoklastische Vaskulitis ; Hypergammaglobulin?mie ; Diagnostik ; Polyarteritis nodosa ; Immune complex diseases ; Cutaneous leukocytoclastic vasculitis ; Hypergammaglobulinemia ; Diagnosis
• 刊名：Der Hautarzt
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：66
• 期：8
• 页码：589-598
• 全文大小：702 KB
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  20.Sunderk?tter C (2012) Vaskulitis und Vaskulopathien In: Plewig G, Landthaler M, Burgdorf W, Hertl M, Ruzicka T (Hrsg) Braun Falco?s Dermatologie, Venerologie und Allergologie. Springer, Heidelberg, S?1054-108View Article
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• 作者单位：Prof. Dr. C. Sunderk?tter (1) (2)
  K.I. Pappelbaum (1)
  J. Ehrchen (2)
  
  1. Abteilung für Translationale Dermatoinfektiologie, Medizinische Fakult?t, Universit?t Münster und Universit?tsklinikum Münster, R?ntgenstra?e 21, 48149, Münster, Deutschland
  2. Klinik für Hautkrankheiten, Universit?tsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
  
• 刊物主题：Dermatology; Immunology; Allergology; Proctology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1432-1173

文摘

The skin is one of the organs most frequently involved in vasculitides. Cutaneous vasculitis may present (1)?part of a systemic vasculitis (e.g., IgA vasculitis), (2)?a skin-restricted or skin-dominant variant of the corresponding systemic vasculitis without clinically apparent visceral involvement (e.g., cutaneous IgA vasculitis), or (3)?a vasculitis occurring exclusively in the skin (e.g., erythema elevatun diutinum). The clinical symptoms of vasculitides are markedly determined by the size of the predominantly affected blood vessels. Systemic polyarteritis nodosa is regarded as a medium vessel vasculitis and is associated with multiple skin symptoms: (1)?vasculitis of digital arteries with ensuing digital infarction, (2)?livedo racemosa and subcutaneous nodules, and (3)?in some patients even purpura and hemorrhagic macules due to additional small vessel vasculitis. In contrast, in its skin-restricted entity (i.e., cutaneous polyarteritis nodosa), the predominant symptoms are subcutaneous nodules surrounded by livedo racemosa, often on the lower legs. Among small-vessel vasculitides palpable purpura with predilection for the legs is a nearly pathognomonic feature of immune complex vasculitis. Variations in clinical symptoms indicate additional pathophysiological mechanisms or different vascultides: (1)?ANCA-associated vasculitides often also entail nodules or sometimes livedo, (2)?cryoglobulinemic vasculitis additionally may present with necrosis at cold exposed areas and involvement of vessels of various size, (3)?small vessel vasculitis associated with systemic lupus erythematosus or rheumatoid arthritis shows predilection for additional sites (e.g., nailfolds) and also involvement of vessels beyond postcapillary venules, (4)?recurrent macular vasculitis in hypergammaglobulinemia also occurs on dependent parts, but shows numerous small hemorrhagic macules instead of palpable purpura, (5)?erythema elevatum diutinum begins with brightly red to violaceous plaques at extensor sites, followed by fibrotic nodules. Consequently, cutaneous symptoms provide pivotal clues for further diagnosis and ensuing management of vasculitides.