Acrally distributed dermatoses: Vascular dermatoses (purpura and vasculitis)

Abstract Purpuric lesions appear in acral distribution in a variety of conditions and often provide clues to the clinical diagnosis. Purpuric means “hemorrhagic”—that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution...

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Veröffentlicht in:Clinics in dermatology 2017-01, Vol.35 (1), p.68-80
Hauptverfasser: Kazandjieva, Jana, MD, PhD, Antonov, Dimitar, MD, PhD, Kamarashev, Jivko, MD, PhD, Tsankov, Nikolai, MD, PhD, DrSci
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container_title Clinics in dermatology
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creator Kazandjieva, Jana, MD, PhD
Antonov, Dimitar, MD, PhD
Kamarashev, Jivko, MD, PhD
Tsankov, Nikolai, MD, PhD, DrSci
description Abstract Purpuric lesions appear in acral distribution in a variety of conditions and often provide clues to the clinical diagnosis. Purpuric means “hemorrhagic”—that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution from the large groups of the vasculitic diseases and their mimics. Cutaneous small vessel vasculitis is confined to the skin, involves mainly postcapillary venules, and has the hallmark manifestation of palpable purpura. Henoch-Schönlein purpura is an immune complex–mediated systemic vasculitis of the small vessels with manifestations from the skin, joints, kidneys, and gastrointestinal system. Only cases where the immune complexes contain immunoglobulin A type are classified as Henoch-Schönlein purpura. Cryoglobulinemic vasculitis is induced by the deposition of cold-precipitated immune complexes in the small vessels. Urticarial vasculitis comprises a spectrum of conditions with the characteristic course of chronic urticaria, with wheals that persist longer than 24 hours, leave hyperpigmentation, and have leukocytoclastic vasculitis on histologic examination. Polyarteritis nodosa is a rare multisystem, segmental necrotizing vasculitis of mainly the medium-sized vessels. Pigmented purpuric dermatoses are chronic benign dermatoses characterized by petechiae, purpura, and increased skin pigmentation. The hallmark of pigmented purpuric dermatoses is their orange-brown, speckled, cayenne pepper–like discoloration.
doi_str_mv 10.1016/j.clindermatol.2016.09.013
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Purpuric means “hemorrhagic”—that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution from the large groups of the vasculitic diseases and their mimics. Cutaneous small vessel vasculitis is confined to the skin, involves mainly postcapillary venules, and has the hallmark manifestation of palpable purpura. Henoch-Schönlein purpura is an immune complex–mediated systemic vasculitis of the small vessels with manifestations from the skin, joints, kidneys, and gastrointestinal system. Only cases where the immune complexes contain immunoglobulin A type are classified as Henoch-Schönlein purpura. Cryoglobulinemic vasculitis is induced by the deposition of cold-precipitated immune complexes in the small vessels. Urticarial vasculitis comprises a spectrum of conditions with the characteristic course of chronic urticaria, with wheals that persist longer than 24 hours, leave hyperpigmentation, and have leukocytoclastic vasculitis on histologic examination. Polyarteritis nodosa is a rare multisystem, segmental necrotizing vasculitis of mainly the medium-sized vessels. Pigmented purpuric dermatoses are chronic benign dermatoses characterized by petechiae, purpura, and increased skin pigmentation. 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Purpuric means “hemorrhagic”—that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution from the large groups of the vasculitic diseases and their mimics. Cutaneous small vessel vasculitis is confined to the skin, involves mainly postcapillary venules, and has the hallmark manifestation of palpable purpura. Henoch-Schönlein purpura is an immune complex–mediated systemic vasculitis of the small vessels with manifestations from the skin, joints, kidneys, and gastrointestinal system. Only cases where the immune complexes contain immunoglobulin A type are classified as Henoch-Schönlein purpura. Cryoglobulinemic vasculitis is induced by the deposition of cold-precipitated immune complexes in the small vessels. Urticarial vasculitis comprises a spectrum of conditions with the characteristic course of chronic urticaria, with wheals that persist longer than 24 hours, leave hyperpigmentation, and have leukocytoclastic vasculitis on histologic examination. Polyarteritis nodosa is a rare multisystem, segmental necrotizing vasculitis of mainly the medium-sized vessels. Pigmented purpuric dermatoses are chronic benign dermatoses characterized by petechiae, purpura, and increased skin pigmentation. The hallmark of pigmented purpuric dermatoses is their orange-brown, speckled, cayenne pepper–like discoloration.</description><subject>Arm</subject><subject>Churg-Strauss Syndrome - complications</subject><subject>Churg-Strauss Syndrome - pathology</subject><subject>Dermatology</subject><subject>Embolism - complications</subject><subject>Foot Dermatoses - etiology</subject><subject>Granulomatosis with Polyangiitis - complications</subject><subject>Hand Dermatoses - etiology</subject><subject>Humans</subject><subject>Leg Dermatoses - etiology</subject><subject>Pigmentation Disorders - complications</subject><subject>Pigmentation Disorders - diagnosis</subject><subject>Pigmentation Disorders - pathology</subject><subject>Polyarteritis Nodosa - complications</subject><subject>Polyarteritis Nodosa - pathology</subject><subject>Purpura - complications</subject><subject>Purpura - diagnosis</subject><subject>Purpura - pathology</subject><subject>Purpura Fulminans - complications</subject><subject>Purpura, Schoenlein-Henoch - complications</subject><subject>Purpura, Schoenlein-Henoch - diagnosis</subject><subject>Purpura, Schoenlein-Henoch - therapy</subject><subject>Skin Diseases, Vascular - complications</subject><subject>Vasculitis - complications</subject><subject>Vasculitis - diagnosis</subject><subject>Vasculitis - drug therapy</subject><subject>Vasculitis - pathology</subject><issn>0738-081X</issn><issn>1879-1131</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU2LFDEQhoMo7rj6F6TxtB66rUp6OskehGX9hAEPfuAtZJJqyJjpHpPuhfn3pp1RFk9CIFA89Rb1FGMvEBoE7F7tGhfD4Cnt7TTGhpdaA7oBFA_YCpXUNaLAh2wFUqgaFH6_YE9y3gFACx08ZhdcaqEUrldsc-OSjfFY-ZCnFLbzRL46R2fK19U3m90cbbpXrK4OcyrPVnbw1d1vIEwhv3zKHvU2Znp2_i_Z13dvv9x-qDef3n-8vdnUrhXrqXbSKa37TivRAbckCaQUrode6H7Lkau2WyvbttajVOC1AysEIPhti5Y7ccmuTrmHNP6cKU9mH7KjGO1A45wNqnUJwVZCQa9PqEtjzol6c0hhb9PRIJjFptmZ-zbNYtOANsVmaX5-njNv9-T_tv7RV4A3J4DKtneBksku0ODIh0RuMn4M_zfn9T8xCxqcjT_oSHk3zmkoPg2azA2Yz8tdl7NiJ4ALzsUvV-uiNQ</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Kazandjieva, Jana, MD, PhD</creator><creator>Antonov, Dimitar, MD, PhD</creator><creator>Kamarashev, Jivko, MD, PhD</creator><creator>Tsankov, Nikolai, MD, PhD, DrSci</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170101</creationdate><title>Acrally distributed dermatoses: Vascular dermatoses (purpura and vasculitis)</title><author>Kazandjieva, Jana, MD, PhD ; Antonov, Dimitar, MD, PhD ; Kamarashev, Jivko, MD, PhD ; Tsankov, Nikolai, MD, PhD, DrSci</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c435t-c7c899f6983602ae7e0773cf0f39fb21284658a44ad1780d9c0a33010db41a2c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Arm</topic><topic>Churg-Strauss Syndrome - complications</topic><topic>Churg-Strauss Syndrome - pathology</topic><topic>Dermatology</topic><topic>Embolism - complications</topic><topic>Foot Dermatoses - etiology</topic><topic>Granulomatosis with Polyangiitis - complications</topic><topic>Hand Dermatoses - etiology</topic><topic>Humans</topic><topic>Leg Dermatoses - etiology</topic><topic>Pigmentation Disorders - complications</topic><topic>Pigmentation Disorders - diagnosis</topic><topic>Pigmentation Disorders - pathology</topic><topic>Polyarteritis Nodosa - complications</topic><topic>Polyarteritis Nodosa - pathology</topic><topic>Purpura - complications</topic><topic>Purpura - diagnosis</topic><topic>Purpura - pathology</topic><topic>Purpura Fulminans - complications</topic><topic>Purpura, Schoenlein-Henoch - complications</topic><topic>Purpura, Schoenlein-Henoch - diagnosis</topic><topic>Purpura, Schoenlein-Henoch - therapy</topic><topic>Skin Diseases, Vascular - complications</topic><topic>Vasculitis - complications</topic><topic>Vasculitis - diagnosis</topic><topic>Vasculitis - drug therapy</topic><topic>Vasculitis - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kazandjieva, Jana, MD, PhD</creatorcontrib><creatorcontrib>Antonov, Dimitar, MD, PhD</creatorcontrib><creatorcontrib>Kamarashev, Jivko, MD, PhD</creatorcontrib><creatorcontrib>Tsankov, Nikolai, MD, PhD, DrSci</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinics in dermatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kazandjieva, Jana, MD, PhD</au><au>Antonov, Dimitar, MD, PhD</au><au>Kamarashev, Jivko, MD, PhD</au><au>Tsankov, Nikolai, MD, PhD, DrSci</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acrally distributed dermatoses: Vascular dermatoses (purpura and vasculitis)</atitle><jtitle>Clinics in dermatology</jtitle><addtitle>Clin Dermatol</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>35</volume><issue>1</issue><spage>68</spage><epage>80</epage><pages>68-80</pages><issn>0738-081X</issn><eissn>1879-1131</eissn><abstract>Abstract Purpuric lesions appear in acral distribution in a variety of conditions and often provide clues to the clinical diagnosis. Purpuric means “hemorrhagic”—that is, the lesions do not blanch from pressure. This review focuses on dermatoses that produce hemorrhagic lesions in acral distribution from the large groups of the vasculitic diseases and their mimics. Cutaneous small vessel vasculitis is confined to the skin, involves mainly postcapillary venules, and has the hallmark manifestation of palpable purpura. Henoch-Schönlein purpura is an immune complex–mediated systemic vasculitis of the small vessels with manifestations from the skin, joints, kidneys, and gastrointestinal system. Only cases where the immune complexes contain immunoglobulin A type are classified as Henoch-Schönlein purpura. Cryoglobulinemic vasculitis is induced by the deposition of cold-precipitated immune complexes in the small vessels. Urticarial vasculitis comprises a spectrum of conditions with the characteristic course of chronic urticaria, with wheals that persist longer than 24 hours, leave hyperpigmentation, and have leukocytoclastic vasculitis on histologic examination. Polyarteritis nodosa is a rare multisystem, segmental necrotizing vasculitis of mainly the medium-sized vessels. Pigmented purpuric dermatoses are chronic benign dermatoses characterized by petechiae, purpura, and increased skin pigmentation. The hallmark of pigmented purpuric dermatoses is their orange-brown, speckled, cayenne pepper–like discoloration.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27938815</pmid><doi>10.1016/j.clindermatol.2016.09.013</doi><tpages>13</tpages></addata></record>
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subjects Arm
Churg-Strauss Syndrome - complications
Churg-Strauss Syndrome - pathology
Dermatology
Embolism - complications
Foot Dermatoses - etiology
Granulomatosis with Polyangiitis - complications
Hand Dermatoses - etiology
Humans
Leg Dermatoses - etiology
Pigmentation Disorders - complications
Pigmentation Disorders - diagnosis
Pigmentation Disorders - pathology
Polyarteritis Nodosa - complications
Polyarteritis Nodosa - pathology
Purpura - complications
Purpura - diagnosis
Purpura - pathology
Purpura Fulminans - complications
Purpura, Schoenlein-Henoch - complications
Purpura, Schoenlein-Henoch - diagnosis
Purpura, Schoenlein-Henoch - therapy
Skin Diseases, Vascular - complications
Vasculitis - complications
Vasculitis - diagnosis
Vasculitis - drug therapy
Vasculitis - pathology
title Acrally distributed dermatoses: Vascular dermatoses (purpura and vasculitis)
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