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Dermatology > Purpuric rashes + vasculitis > Flashcards

Purpuric rashes + vasculitis Flashcards

1
Q

What is purpura?

A

non-blanching purple-ish rash
due to leakage of blood (haemorrhage) from skin blood vessels

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2
Q

What does macular purpura normally indicate?

A

usually non-inflammatory cause

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3
Q

What does palpable purpura normally indicate?

A

usually inflammatory cause (eg. vasculitis)

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4
Q

4 general causes of purpura

A

trauma

platelet disorder

vascular disorder (leaky vessels)

coagulation disorder/embolic (usually ecchymoses and external bleeding)

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5
Q

Which coagulation disorders/embolic can cause purpura?

A

DIC
Heparin-induced thrombocytopenia
Warfarin-induced necrosis
Septic emboli/cholesterol emboli

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6
Q

2 types of non-palpable purpura

A

petechiae
ecchymoses

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7
Q

Which diseases can cause petechiae?

A

thrombocytopenia (idiopathic, drug-induced, thrombotic, DIC, infection)

abnormal platelet function

increased intravascular venous pressures

some inflammatory skin diseases

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8
Q

Which diseases can cause ecchymoses?

A

external trauma

DIC and infection

coagulation defects

skin weakness/fragility

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9
Q

Define vasculitis

A

inflammation of blood vessel wall
can happen in small, medium and large vessels
causes leakage of blood –> purpura

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10
Q

Vasculitis causes

A

idiopathic
infection
inflammatory + autoimmune disease
drugs
neoplastic

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11
Q

How is vasculitis classified?

A

by size of vessel

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12
Q

Which infections cause vasculitis?

A

can be any –> often after URTI

bacterial –> meningococcus

viral –> Hep B/C

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13
Q

Name 2 large vessel vasculitides

A

Giant cell (temporal) arteritis
Takayasu’s arteritis

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14
Q

What is GCA associated with?

A

polymyalgia rheumatica

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15
Q

GCA cutaneous involvement

A

rare
usually tender nodules over superficial arteries

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16
Q

GCA systemic manifestations

A

headache
jaw claudication
blindness

17
Q

Who does Takayasu’s arteritis normally affect?

A

young women

18
Q

Where does Takayasu’s arteritis affect?

A

vasculitis of aorta and aortic branches

19
Q

Describe the early phase of Takayasu’s arteritis

A

pre-pulseless systemic disease
subclavian steal syndrome
anaemia
fatigue

erythema nodosum-like nodules

20
Q

Describe the late phase of Takayasu’s arteritis

A

pulselessness with or without signs of ischaemia
hypertension
renal artery stenosis

pyoderma gangrenosum-like lesions

21
Q

Name 2 medium vessel vasculitides

A

polyarteritis nodosa
kawasaki disease

22
Q

Symptoms of polyarteritis nodosa

A

segmental arteritis
livedo reticularis + ulceration possible
generally affects lower extremities
arthralgias + myalgias (polymyositis)
polyneuritis
renal disease
hypertension
microaneurysms
5-10mm subcutaneous nodules distributed segmentally
normal/erythematous overlying skin
may be painful, pulsatile or secondarily ulcerated

23
Q

Kawasaki disease symptoms

A

prolonged fever (at least 5 days)
polymorphous cutaneous eruption (mostly trunk + extremities)
mucous membrane involvement (conjunctival, oropharyngeal)
sometimes can result in coronary artery aneurysms
macular, maculopapular, urticarial, targetoid, scarlatiniform, vesiculopapular, pustular
desquamation at week 2

24
Q

Name 3 small vessel vasculitides

A

Henoch-schonlein purpura (IgA vasculitis)
Wegener’s granulomatosis (granulomatosis with polyangiitis)
Churg-strauss syndrome (eosinophilic granulomatosis with polyangiitis)

25
Q

Who is IgA vasculitis most common in?

A

children <10

26
Q

IgA vasculitis symptoms

A

can precede URTI
symmetrical intermittent palpable purpura on extensor extremities and buttocks
arthralgias and arthritis
haematuria
abdominal pain
melaena
renal involvement
IgA immune deposition in vessel walls
usually mild + self-limiting
erythematous, urticarial papules
rapidly evolves into palpable purpura with haemorrhage in 24 hours

27
Q

Describe granulomatosis with polyangiitis symptoms and skin involvement

A

necrotising granulomatous inflammation of upper and lower respiratory tracts (otitis, epistaxis, sinusitis)

glomerulonephritis (C-ANCA +ve)

systemic vasculitis (skin + oral mucosa, pulmonary infiltrates)

painful subcutaneous nodules, papules, vesicles, petechiae, palpable purpura, pyoderma-gangrenosum-like lesions

28
Q

Describe eosinophilic granulomatosis with polyangiitis symptoms and skin involvement

A

multisystem vasculitis (asthma, eosinophilia, necrotising vasculitis with extravascular granulomas)

asthma + allergic rhinitis

vasculitis involving 2 or more extrapulmonary organs (eg. GI, heart)

palpable purpura and infiltrated nodules

can be P-ANCA +ve

29
Q

What is the most common type of vasculitis?

A

cutaneous leukocytoclastic vasculitis/cutaneous small vessel vasculitis/hypersensitivity vasculitis

(same things, different names)

30
Q

Describe cutaneous small vessel vasculitis

A

affects small vessels/post-capillary venules
women>men (children + adults)
circulating immune complexes deposited in walls of affected blood vessels
lesions on ankles/lower legs/pressure points

palpable purpura, lesions ranging 1mm-several cms
urticaria or ulcers possible

31
Q

Vasculitis investigations (history)

A

History:
- associated symptoms = haematuria, haemoptysis, sinusitis, SOB/cough

  • triggers = drug/infection, constitutional symptoms
32
Q

Vasculitis examination findings

A

vital signs = pyrexial, hypertensive

distribution + description of rash - palpable?

head + neck = sinusitis, chondritis, otitis, iritis

renal = tenderness to palpation

liver = hepatosplenomegaly

pulmonary = crackles

33
Q

Vasculitis investigations

A

Basic bloods:
- FBC
- U&Es
- LFTs

Immunology:
- rheumatoid factor
- ANA
- ANCA
- Complement
- protein + Ig electrophoresis
- cryoglobulins

Infection:
- anti-hep B/C antibodies/HIV
- anti-streptococcal antibodies
- blood cultures

non-blood tests:
- urinalysis
- BP
- skin biopsy with immunofluorescence <48 hours

Imaging:
- sinus radiographs+ CT
- CXR/CT
- ECG
- ECHO

34
Q

Vasculitis treatment

A

rash can resolve spontaneously in most cases

observation

treat underlying cause (treat infection, stop medication, treat neoplasm)

rest + elevation (reduce oedema + stasis)

analgesia

protect fragile skin from injury

severe or persistent cases = corticosteroids, colchicine, NSAIDs (indomethacin), dapsone, hydroxychloroquine

Dermatology (23 decks)

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