Cutaneous Vasculitis: Causes, Signs, Symptoms, Treatment, Prognosis, Epidemiology

Inflammation and redness of the skin followed by outbreak of rashes affect a large section of the population regularly. Most would put down these manifestations as some form of skin infection or the other. However, such manifestations might also have more serious explanations, such as Cutaneous Vasculitis. It is, therefore, important to understand what the disease is and the various forms of its manifestations in order to get proper treatment for the same.

Vasculitis may be defined as an inflammatory and destructive process that affects the walls of the blood vessels, generally that of the small and medium, in the subcutaneous tissue and the skin. This condition covers all types of blood vessels, such as, venules, arterioles, capillaries and lymphatics, and the internal organs and tends to manifest in the form of lesions such as, petechiae, ulcers and purpura.

There are certain overlapping terms that are used for the description of Cutaneous Vasculitis, some of which are-

• Cutaneous Small-Vessel Vasculitis- This refers to the type of vasculitis that affects the small blood vessels of the skin but not the internal organs.
• Leukocytoclastic Vasculitis- This refers to the inflammation affecting the neutrophilis at the initial stages, whereupon the leukocytoclasis gets deposited in the walls of the vessels.
• Hypersensitivity Vasculitis- This generally refers to Cutaneous small-vessel Vasculitis caused due to drugs or some kind of infection.

Cutaneous Vasculitis can be largely classified into four broad categories, viz-

• Cutaneous Large Vessel Vasculitis
• Cutaneous Medium Vessel Vasculitis
• Cutaneous Small Vessel Vasculitis
• Cutaneous Variable Vessel Vasculitis

Patients of Cutaneous Vasculitis manifest a number of signs and symptoms that can be easily linked to the disease. Some of the symptoms that patients might manifest if the skin involvement is of primary issue are-

• Lesions, such as, Petechiae, Purpura, Livedo Reticularis, Nodules, Urticaria and Ulcers
• Headache, fever and fatigue
• Weight loss
• A feeling of numbness or weakness
• Rashes.

Cutaneous Vasculitis patients may also suffer from arthralgias, fever, involvement of other organs or a combination of these in case of the involvement of the skin being a secondary issue.

Cutaneous Vasculitis is a quite common occurrence among people of various age groups all over the globe. While Cutaneous Vasculitis is basically limited to the skin and excludes internal organs, the treatment depends on the identification and removal of the causes. While milder form of Cutaneous Vasculitis can be treated by avoiding the triggering factors and consumption of prescribed dosages of dapsone and colchicines, the more severe form of Cutaneous Vasculitis are treated with the help of immunosuppression and systemic corticosteroids.

Cutaneous Vasculitis has been found to be quite common among the population, very much like that of Systemic Vasculitis.

There might be a number of reasons for the blood vessels responding by inflammatory reactions, thereby leading to Cutaneous Vasculitis. However, all of the causative factors can be largely grouped into three heads, the combination of one or more than factor triggering the disease-

• Direct abrasion to the walls of the blood vessels by means of microbes, such as bacteria and virus
• Indirect abrasion caused by the incitement of antibodies, thereby, generating inflammation of the walls of the blood vessels
• Indirect abrasion by means of incitement of complement, which can be defined as a class of proteins present in the blood and tissue fluids that assault foreign bodies and other such contamination, thereby harming the walls of the blood vessels.

There are a number of other factors as well that are the causative factors behind Cutaneous Vasculitis-

• Cutaneous Vasculitis Caused due to Drugs- Antibiotics, Thiouracil, Thiazide Diuretics, Anticoagulants, Non- Steroidal Anti Inflammatory drugs and the like are some of the drugs that can trigger Cutaneous Vasculitis.
• Food- Though rarely found to be the causative factor; certain food additives such as tartrazine can also cause Cutaneous Vasculitis.
• Reduction in Blood Flow- Factors such as high levels of fat, varicose veins, cold weather, deposition of fibrin and the like leads to reduced flow of blood, resulting in Cutaneous Vasculitis.
• The body produces elevated number of antibodies in order to fight malignant diseases such as cancer, thereby increasing sludge in the blood, leading to Cutaneous Vasculitis.
• Certain diseases such as, Systemic Lupus Erythamatosus, Dermatomyositis, Polyarteritis Nodosa, Rheumatoid Arthritis and the like produce antibodies which attack the tissues of the body. Such diseases are termed autoimmune diseases and they can cause considerable damage to the walls of the blood vessels, leading to Cutaneous Vasculitis.

Diagnosis of Cutaneous Vasculitis involves a number of procedures, some of which includes-

• Biopsy. Skin Biopsy should ideally be conducted within 48 hours of the occurrence of the lesions. Excision Biopsy or Deep Punch Biopsy into the subcutis is generally considered favorable for a better detection of the disease.
• Certain routine tests such as CBC, Urinalysis, Chest X-Ray, ESR, Serum Creatinine and the like may also be conducted.
• Examinations are also made so as to determine the etiology and the type of vasculitis, for instance, antineutrophil cytoplasmic, complement factors, rheumatoid factor, protein electrophoresis and the like.

Since Cutaneous Vasculitis is limited to the inflammation and necrosis of the walls of the blood vessels of the skin, the diagnosis generally involves an exhaustive physical and historical examination, the process focusing on identification of causes such as, infections or drugs, duration of the signs and symptoms, meticulous review of all the systems, current illness and the like.

Diagnosis also involves the exclusion of Vasculitis in other organs as well, including-

• Kidneys- Manifested in the form of Edema
• Intestine- Manifested in the form of diarrhea, bloody stools, abdominal pain and the like
• Lungs- Manifested in the form of hemoptysis, coughing, shortness of breath and the like.
• Nerves- Manifested in the form of Paresthesias.

While diagnosing for Cutaneous Vasculitis, Urinalysis should eliminate protein, RBC casts and blood. While CBC and other such blood examinations are conducted to determine if the patient is suffering from anemia, analyze the increased levels of acute phase reactants, such as C- reactive protein, ESR and determine the levels of serum creatinine, and platelet count.

Cutaneous Vasculitis can be mimicked by a number of other conditions such as-

• Insect bites
• Pityriasis lichenoides
• Trauma
• Purpura etc.

It is important to take all of the above conditions into consideration before arriving at a conclusion. This kind of diagnosis is termed as differential diagnosis and is considered to be imperative for the accurate diagnosis of the disease.

Since Cutaneous Vasculitis is limited to the skin, its treatment is relatively simpler than other forms of Vasculitis. Simple measures such as elevating the leg, and therapies can cure the milder forms of Cutaneous Vasculitis. However, there are other forms of treatment as well that one could consider, such as-

• Identification of the cause of Cutaneous Vasculitis and directing the treatment in the direction is one of the very first steps that can be taken in order to cure Cutaneous Vasculitis.
• Circumvention of triggers such as, infections, drugs and other such factors can reduce the chances of such diseases.
• Mild form of Cutaneous Vasculitis can also be treated by means of certain drugs such as, dapsone and colchicines.
• The severe form of Cutaneous Vasculitis can be treated by means of systemic corticosteroids or by means of immunosuppression such as, azathioprine, methorexate, cyclophosphamide and the like.

Patients may also suffer from certain complications due to the treatment of Cutaneous Vasculitis, depending on the size of the blood vessel, cause of the disease and the affected organs. Some of the complications that a Cutaneous Vasculitis patient might have to face are-

• Pulmonary hemorrhage
• Venous or Arterial thrombosis
• Subglottic stenosis
• Central Nervous System infraction.

Hence, one could conclude that Cutaneous Vasculitis is one of the simplest forms of Vasculitis among all others, with the primary issue being related to the skin. Treatment of Cutaneous Vasculitis is also quite simple if one is capable of identifying the causes and taking steps towards cure accordingly and also actively prevent in further worsening of symptoms.