A Study and Analysis of Cutaneous Small Vessel Vasculitis

Jayanthi, O R (2011) A Study and Analysis of Cutaneous Small Vessel Vasculitis. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION : Vasculitis is inflammatory process affecting the vessel walls and leading to its compromise or destruction and subsequent hemorrhagic and ischemic events. Vessels of any organ can be affected that results in a wide variety of signs and symptoms The unique feature of this group is multiorgan involvement. Because of the rich vasculature, the skin is prone to be frequently affected in vasculitis. Cutaneous involvement in vasculitides may be primary or reflector of a fatal systemic disease or evidence of association with some other systemic disorder. Cutaneous vasculitic lesions offer a window to diagnosis and a ready source of accessible tissue for histopathologic examination. Small vessel vasculitis is defined as one which affects mostly vessels smaller than arteries such as arterioles, capillaries and venules. These heterogeneous clinical manifestations, combined with the etiologic non specificity of the histologic lesions, complicate the diagnosis of specific form of vasculitis.The gold standard for a diagnosis of vasculitis is histologic confirmation on biopsy, as few forms of vasculitis have a pathognomonic laboratory or imaging finding. As a clinicopathological process, vasculitis occurs both as a primary process or idiopathic vasculitis and as a secondary feature of other diseases such as collagen vascular diseases, infectious disorders, malignancy and adverse drugs reaction. Many times the initial presentation of vasculitis is on the skin and it is the dermatologist who must diagnose and treat this challenging condition. AIM OF THE STUDY : 1. To study the epidemiological spectrum of cutaneous small vessel vasculitides. 2. To determine the clinicopathological correlation. MATERIALS AND METHODS : A study was conducted during the period from May 2008 – May 2010 in the department of dermatology, Govt Rajaji Hospital, Madurai Medical college, Madurai, among the patients with cutaneous small vessel vasculitis attending the dermatology department as well as those referred from other departments mainly Medicine, Rheumatology and paediatrics. Inclusion criteria: All patients with clinical features suggestive of small vessel vasculitis i.e palpable purpura, infiltrated erythema, hemorrhagic vesicles and bulla, ulcers, infarct, digital gangrene, erythematous plaques and nodules, urticaria, livedoreticularis which was subsequently supported by histopathological examination. Exclusioncriteria: 1. Patients who were unwilling for the study. 2. Patients with abnormal bleeding parameters. A proforma was filled for all patients. SUMMARY : 40 patients, diagnosed with cutaneous small vessel vasculitides, based on history, clinical features, laboratory findings, histopathology were included in the study. This study was done for a period of 24 months ( May2008 to May 2010). Sex: 15 were male (38%) and 25 were female (62%). The male : female ratio was 1:1.7. Age: Majority of patients were between the ages of 11 – 40 years. The mean age of our study group was 31 years for males and 24 years for females. Clinical spectrum: The common types of cutaneous small vessel vasculitis included Henoch Schonlein purpura (45%), Erythema nodosum leprosum (25%), connective tissue disorders with vasculitis (17.5%). The less common types were urticarial vasculitis (5%), septic vasculitis (5%) and Essential mixed cryoglobulinemic vasculitis (2.5%). Aetiology: Infections (55%) mainly the upper respiratory tract infections were the commonest underlying cause encountered in our study followed by collagen vascular disorder (17.5%) and drugs (15%). Symptoms associated with skin lesions: Itching was the predominant symptom noted in 30 % of patients followed by fever and burning sensation. Systemic symptoms: Joint pain was the most common systemic symptom observed in 47.5% of patients followed by joint swelling. In patients of HSP with renal involvement, three had extensive cutaneous lesions all over the body while seven patients had musculoskeletal symptoms. Morphology & distribution: The morphology of lesions and their distribution were concordant with those described in the literature. Clinically most of the patients presented with palpable purpura in the dependent parts especially the legs. Legs involvement and palpable purpura were noted in 100% of cases of Henoch Schonlein purpura. Koebner phenomenon was observed in two patients. Laboratory findings: Common laboratory findings observed were elevated ESR(67.5%), and anemia (40%). Histopathology: Leukoocytoclastic vasculitis was the most common histopathological pattern observed in 34 cases. We found a significant proportion(25%) of patients with ENL presenting as leukocytoclastic vasculitis in addition to mixed panniculitis. CONCLUSION : 1. Henoch Schonlein purpura was the most common cutaneous small vessel vasculitis followed by Erythema nodosum leprosum. 2. Cutaneous small vessel vasculitis was more common in females. 3. Majority of the patients were between 11 – 40 years of age. 4. Upper respiratory tract infection was the commonest etiologic factor in cutaneous small vessel vasculitis. 5. Joint pain was the common systemic symptom found in majority of patients. 6. Nonthrombogenic palpable purpura represents clinical hallmark in cutaneous small vessel vasculitis. 7. Widespread cutaneous manifestations may be the cutaneous marker of serious systemic involvement. 8. Elevated ESR and anemia were the common laboratory abnormalities. 9. Leukocytoclastic vasculitis was the common histopathological pattern in cutaneous small vessel vasculitis. 10. Significant proportion of patients with Erythema nodosum Leprosum presenting as leukocytoclastic vasculitis . 11. Early biopsy and Clinicopathological correlation is necessary for the diagnosis of cutaneous small vessel vasculitis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cutaneous Small Vessel Vasculitis ; Analysis.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 03:27
Last Modified: 03 Mar 2018 02:38
URI: http://repository-tnmgrmu.ac.in/id/eprint/5972

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