Vasculitis

Inflammation associated with immune complexes in the capillaries and small blood vessels is part of the pathological changes of many of the conditions described above. The term vasculitis is also used clinically to describe a variable clinical picture with red macules and papules and with necrosis and bruising in severe cases. In children purpura is more prominent and these cases are classified as Henoch-Schonlein purpura. The legs and arms are usually affected. Skin signs are preceded by malaise and fever with arthropathy and there may be associated urticaria. As a high proportion of cases are associated with systemic lesions, it is essential to check for renal, skeletal, gastrointestinal, and central nervous system disease. In children with Henoch-Schonlein purpura nephritis is common.

Vasculitis

• Inflammation around dilated capillaries and small blood vessels

• A common component of the erythemas

• May occur as red macules and papules with necrotic lesions on the extremities

• In children a purpuric type (Henoch-Schonlein purpura) occurs in association with nephritis

• Systemic lesions may occur, with renal, joint, gastrointestinal, and central nervous system involvement

Purpura

Is seen on the skin as a result of:

Thrombocytopenia—platelet deficiency

• Senile purpura—due to shearing of capillaries as a result of defective supporting connective tissue

• Purpura in patients on corticosteroid treatment—similar to senile purpura

• Schamberg's disease—brown macules and red spots resembling cayenne pepper on the legs of men

• Associated vasculitis

Some conditions associated with vasculitis

• Infection—streptococcal, hepatitis

• Drugs—numerous, including sulphonamides, penicillin, phenothiazine, phenacitin

• Chemicals—insecticides, weed killers, phenolic compounds

• Connective tissue diseases—systemic lupus erythematosus, rheumatoid arthritis

• Lymphoma and leukaemia

• Dysproteinaemias

Fixed drug eruption

Drug reactions

Blistering eruptions

• Barbiturates

• Sulphonamides

• Iodines or bromides

• Chlorpropamide

• Salicylates

• Phenylbutazone Lichen planus like reactions

• Chloroquine

• Chlorothiazide

• Chlorpropamide

Photosensitivity (seen on areas exposed to light)

• Thiazide diuretics

• Sulphonamides

• Tetracyclines

Vasculitis

Acute vasculitis with necrosis

Necrotising angiitis

Acute vasculitis with necrosis

Necrotising angiitis

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