Сutaneous vasculitis: classification, diagnosis and differential diagnosis (part 1)

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Abstract

Cutaneous vasculitis is a heterogeneous group of diseases caused by inflammation of the blood vessel wall of the skin. The variety of cutaneous vasculitis, their clinical similarity, lack of clear diagnostic criteria and common terminology cause an extremely complex process of diagnosis of this group of diseases. A dermatologist is often the first specialist to diagnose vasculitis. Currently there is no single "monodisciplinary" classification of v ascular damage, there is no generally accepted terminology and classification of cutaneous vasculitis. In domestic dermatovenerology, vasculitis is classified according to the morphological elements of the skin rash, and not by etiology and pathogenesis. This makes it difficult for different specialists to understand the diagnosis and maintain continuity in the management of patients.

The article presents the nomenclature of vasculitis of the 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides, supplemented by organ-specific cutaneous vasculitis, describes the pathomorphological and clinical manifestations of this group of dermatoses, summarizes information about modern treatment tactics.

About the authors

Vladislav R. Khairutdinov

Military medical academy of S.M. Kirov

Author for correspondence.
Email: haric03@list.ru

Dr. Sci. (Med.)., Assoc. Prof., Assoc. Prof. of the Department of Skin and Sexually Transmitted Diseases

Russian Federation, 6G, Akademika Lebedeva street, Saint-Petersburg, 194044

Irena E. Belousova

Military medical academy of S.M. Kirov

Email: irena.belousova@mail.ru

Dr. Sci. (Med.)., Assoc. Prof., Prof. of the Department of Skin and Sexually Transmitted Diseases

Russian Federation, 6G, Akademika Lebedeva street, Saint-Petersburg, 194044

Aleksey V. Samtsov

Military medical academy of S.M. Kirov

Email: avsamtsov@mail.ru

Dr. Sci. (Med.)., Prof., Head of the Department of Skin and Sexually Transmitted Diseases

Russian Federation, 6G, Akademika Lebedeva street, Saint-Petersburg, 194044

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2. Fig. 1. Leukocytoclastic vasculitis. Neutrophilic granulocytes in the wall and around the dermis' surface vessels, fragments of neutrophil nuclei (nuclear dust, leukocytoclasia), edema, and fibrinoid necrosis of vessel walls

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3. Fig. 2. Leukocytoclastic vasculitis. Severe edema of the papillary dermis. Perivascular neutrophilic infiltrate with leukocytoclasia

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4. Fig. 3. Nodular (erythema induratum) vasculitis. Lesions of the septal artery of the hypoderm (septal vasculitis). Muscular layer neutrophilic leukocyte infiltration, edema and proliferation of endothelial cells

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5. Fig. 4. Nodular (erythema induratum) vasculitis. Lesions of venules of fatty lobules (lobular vasculitis). Necrosis and neutrophilic leukocyte infiltration of vein walls with thrombosis

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6. Fig. 5. Erythema elevatum diutinum. Infiltration of the dermis with neutrophilic leucocytes. Leukocytoclastic vasculitis of small-caliber vessels

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7. Fig. 6. Rheumatoid vasculitis. Necrobiotic palisade granuloma in the dermis (i.e. blue granuloma), and neutrophilic infiltration with necrosis of the small-caliber vessels' walls

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Copyright (c) 2020 Khairutdinov V.R., Belousova I.E., Samtsov A.V.

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