This week sees the start of a new topic as we turn our attention to the condition known as vasculitis. Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction. While vasculitis can be triggered by a number of conditions, including diseases of the connective tissue, malignancy, or a drug reaction, the condition can often be idiopathic with no identifiable cause.(1–3)

The term vasculitis covers a range of conditions which manifest in different ways depending on the  size of the blood vessels affected.  Systemic effects include fever, joint pain, and malaise. Many of the systemic vasculitis syndromes have a cutaneous component, and patients with small, medium, or large-vessel disease may initially present to a dermatologist for diagnosis and management.(4) Vasculitis of the small dermal vessels manifests as palpable purpura, vesicobullous lesions, and superficial ulcers with regular borders. Vasculitis of the muscular arteries presents as painful red nodules, punched-out irregularly shaped ulcers, or gangrene.(2)

Vasculitis affects individuals of all ages, although the young and elderly are disproportionately affected.(4)  Because the etiology of the condition is poorly understood, accurate epidemiological studies are difficult to perform, and the true extent of the condition is not well known.(4) However, it seems that there is an ethnic element to the condition, with some races succumbing to certain subtypes of vasculitis more readily than others.(4)

As we will see in later weeks, the diagnosis of vasculitis can be problematic and requires a skin biopsy to eliminate other similar conditions. Once diagnosed, the underlying causes of the condition should first be addressed, and the lesions managed according to their severity.(5)

If you are interested in studying lesions due to vasculitis and other unusual wound presentations in greater depth, you  may wish to consider pursuing some form of ongoing professional development. A certification in wound care provides the opportunity to study certain issues in more detail, while also improving your own career prospects. For further information, please visit www.woundeducators.com.

References

1.              de Araujo T and Kirsner RS. Atypical wounds. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.

2.              Panuncialman J and Falanga V. Unusual causes of cutaneous ulceration. Surg Clin North Am 2010; 90: 1161-1180.

3.              Ferreira MC, Junior PT, Carvalho VF and Kamamoto F. Clinics 2006; 61: 571-578.

4.              Ball GV, Bridges SL Jr. Vasculitis. 2nd Edition. Oxford University Press, Oxford, UK. 2008.

5.              Chung L and Fiorentino D. Cutaneous Vasculitis. Orphanet encyclopedia, March 2005 (available from http://www.orpha.net/data/patho/GB/uk-cutaneous-vasculitis.pdf)