This week sees the start of a new topic as we turn our attention to the condition known as vasculitis. Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction. While vasculitis can be triggered by a number of conditions, including diseases of the connective tissue, malignancy, or a drug reaction, the condition can often be idiopathic with no identifiable cause.(1–3)
What is Vasculitis?
Vasculitis is an inflammation of the blood vessels. Vasculitis causes changes in the walls of the blood vessels, including thickening, weakening, narrowing, and scarring. Inflammation can be so severe that the tissues and organs supplied by the affected vessels do not get enough blood. The resulting blood shortage can result in organ and tissue damage or even death.
Many Variations of Vasculitis
The term vasculitis covers a range of conditions which manifest in different ways depending on the size of the blood vessels affected. Systemic effects include fever, joint pain, and malaise. Many of the systemic vasculitis syndromes have a cutaneous component, and patients with small, medium or large-vessel disease may initially present to a dermatologist for diagnosis and management. (4) Vasculitis of the small dermal vessels manifests as palpable purpura, vesiculobullous lesions, and superficial ulcers with regular borders. Vasculitis of the muscular arteries presents as painful red nodules, punched-out irregularly shaped ulcers, or gangrene. (2)
Vasculitis affects individuals of all ages, although the young and elderly are disproportionately affected.(4) Because the etiology of the condition is poorly understood, accurate epidemiological studies are difficult to perform, and the true extent of the condition is not well known.(4) However, it seems that there is an ethnic element to the condition, with some races succumbing to certain subtypes of vasculitis more readily than others.(4)
Diagnosis of Vasculitis
As we will see in later weeks, the diagnosis of vasculitis can be problematic and requires a skin biopsy to eliminate other similar conditions. The true diagnosis of vasculitis is made by clinical evaluation and tissue biopsies. Treatment of the vasculitis is based on the extent of the disease. Treatments include the use of systemic steroids, other anti-inflammatory agents or immunosuppressants, among other potential agents. It is important to remember that other conditions such as embolic and Thrombotic diseases can mimic vasculitis. Therefore, a definitive diagnosis should always precede treatment.
Once diagnosed, the underlying causes of the condition should first be addressed, and the lesions managed according to their severity.(5)
More About Vasculitis
If you are interested in studying lesions due to vasculitis, see our full vasculitis lecture series:
and other unusual wound presentations in greater depth, you may wish to consider pursuing some form of ongoing professional wound management development. A certification in wound care provides the opportunity to study certain issues in more detail, while also improving your own career prospects.
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- de Araujo T and Kirsner RS. Atypical wounds. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.
- Panuncialman J and Falanga V. Unusual causes of cutaneous ulceration. Surg Clin North Am 2010; 90: 1161-1180.
- Ferreira MC, Junior PT, Carvalho VF and Kamamoto F. Clinics 2006; 61: 571-578.
- Ball GV, Bridges SL Jr. Vasculitis. 2nd Edition. Oxford University Press, Oxford, UK. 2008.
- Chung L and Fiorentino D. Cutaneous Vasculitis. Orphanet encyclopedia, March 2005 (available from http://www.orpha.net/data/patho/GB/uk-cutaneous-vasculitis.pdf)