Vasculitis-related Skin Lesions: Anticipated Manifestations, Therapeutic Measures, and Other Information
Vasculitis, an inflammation of the blood vessels, can manifest in various ways, and one common symptom is a rash on the skin. Here's a breakdown of the different types of vasculitis rashes and what they might indicate.
Palpable Purpura: Small Vessel Vasculitis
Palpable purpura is a hallmark of small vessel vasculitis, such as leukocytoclastic vasculitis and Henoch-Schönlein purpura/IgA vasculitis. This rash appears as raised, red-purple spots caused by inflammation and bleeding in small vessels.
Polymorphic Rash: Kawasaki Disease (Medium Vessel Vasculitis)
Kawasaki disease, primarily affecting children, presents with a polymorphic rash that is variable in appearance. This rash can be accompanied by mucous membrane changes such as conjunctival injection, lip mucositis, and erythema/edema of hands and feet.
Urticarial Vasculitis Rash: Small Vessel Vasculitis
Urticarial vasculitis is characterized by erythematous, edematous, annular, and papular lesions that typically last longer than normative urticaria (24–72 hours) and are often intensely itchy. This rash commonly affects the trunk, neck, and palms, sometimes involving eye inflammation (episcleritis).
Nodules or Ulcers: Medium Vessel Vasculitis
Medium vessel vasculitis, like polyarteritis nodosa, may present with skin nodules or painful ulcers.
Annular Erythematous Papular Rash: Urticarial Hypocomplementemic Vasculitis Syndrome
This rash manifests as red, elevated, ring-like lesions that spontaneously resolve and recur over days.
The specific features of the vasculitis rash help indicate the affected vessel size and the underlying disease process, aiding diagnosis and management. In patients, palpable purpura is the most typical rash signaling small vessel vasculitis. Kawasaki disease shows a polymorphic rash with systemic signs mostly in children, whereas urticarial vasculitis presents with transient, itchy, annular lesions.
In more advanced cases, treatment may include steroids, immunosuppressant medications, and anti-inflammatory drugs. Over-the-counter medications like ibuprofen may also be part of the treatment plan. However, it's important to note that some people may not require prescription medication, as their condition may resolve with antihistamines or ibuprofen.
Anyone experiencing symptoms of skin vasculitis, such as a rash with a red, purple, or brownish tint, blisters, sores across the lower body, or hives, should consult a doctor for a complete evaluation. A skin biopsy is often performed to help confirm a diagnosis of vasculitis.
It's crucial to remember that diagnosing vasculitis with symptoms alone can be challenging, and it's always best to consult a medical professional if you notice a new, unexplained rash. In IgA vasculitis, the antibody IgA aggregates in small blood vessels, causing them to become inflamed and leak blood.
Returning to mild exercise as soon as vasculitis symptoms permit is important during recovery to increase joint strength and flexibility. In some cases, certain arthritis medications, such as etanercept (Enbrel), can help with skin vasculitis by reducing inflammation and joint swelling.
While vasculitis can lead to serious health complications, such as kidney failure, complications in the eyes and lungs, permanent damage to blood vessels, and scarring of the skin, many cases can be managed effectively with proper medical care and early intervention.
- Leukocytoclastic vasculitis and Henoch-Schönlein purpura, forms of small vessel vasculitis, can exhibit palpable purpura - raised, red-purple spots caused by inflammation and bleeding in small vessels.
- Kawasaki disease, a medium vessel vasculitis primarily affecting children, presents with a polymorphic rash that is variable in appearance.
- Urticarial vasculitis, another small vessel vasculitis, is characterized by itchy, erythematous, edematous, annular, and papular lesions that last longer than standard urticaria.
- Polyarteritis nodosa, a medium vessel vasculitis, may manifest as skin nodules or painful ulcers.
- The Urticarial Hypocomplementemic Vasculitis Syndrome shows a rash of red, elevated, ring-like lesions that spontaneously resolve and recur over days.
- The specific features of the vasculitis rash can help determine the affected vessel size and underlying disease process, aiding diagnosis and management in patients.
- Over-the-counter medications like ibuprofen may be part of the treatment plan for some people with skin vasculitis, but steroids, immunosuppressant medications, and anti-inflammatory drugs might also be necessary.
- A skin biopsy is often performed to help confirm a diagnosis of vasculitis.
- In IgA vasculitis, the antibody IgA aggregates in small blood vessels, causing them to become inflamed and leak blood.
- Proper medical care and early intervention can significantly help manage the complications of vasculitis, which can lead to kidney failure, complications in the eyes and lungs, permanent damage to blood vessels, and scarring of the skin.
