Describe this finding.
-Bilateral symmetric lower extremity erythematous rash.
-Some of the smaller lesions on the legs look petechial.
-Also larger erythematous papules and plaques.
Corresponds with this image of feet
Lesions of cutaneous vasculitis: do they blanch witt pressure? why?
They don't blanch since the blood has extravasated from the vessels due to damaged blood vessel walls.
The lesions of cutaneous vasculitis usually occur in what pattern? what body parts?
symmetric distribution of lower extremeties or dependent areas.
cutaneous vasculitis: are the lesions usually symptomatic or asymptomatic? if sympt, what are the sx?
But if there are sx, there may be itching, burning or pain
Cutaneous vasculitis: what sized vessels are involved?
small to medium sized vessels
Cutaneous vasculitis: what test must be performed in order to distinguish this from other disorders with a similar appearance?
Must do a BIOPSY.
What features on histology will help confirm a diagnosis of cutaneous vasculitis?
-Inflammatory infiltrates surrounding or invading blood vessels
-disruption/destruction of vessel walls by inflammatory infiltrate
-fibrinoid necrosis (fibrin deposition within the vessel wall or in the lumen)
what feature of histology can help distinguish between different types of vasculitis?
the type of inflammatory infiltrate can help.
neutrophilic, lymphocytic, eosinophilic or granulomatous inflammation all suggest different diagnoses
why is it particularly important to consider a differential dx when thinking about a cutaneous vasculitis?
-cutaneous vasculitis is secondary to another underlying condition in 70% of cases
-also, cutaneous vasculitis is a dx of exclusion
what are some of the other dx to consider with cutaneous vasculitis? (ie whats on the differential)?
-viral infections (Hep B/C, HIV)
-acute bacterial infections (meningococcus, gonococcus)
-bacterial endocarditis, fungal
-drug induced hypersensitivity vasculitis
-systemic vasculitis: ANCA-associated, polyarteritis nodosa
to confirm a cutaneous vasculitis, what tests might you perform and what might they tell you?
(there are a lot; these are just a few)
-cANCA to r/o Wegener's
-pANCA to r/o microscopic polyarteritis
-CBC for signs of infection (decr WBC, Hgb, platelets -> connective tissue disease. high WBC indicates infection or malignancy)
-ANA, C3, C4 to evaluate lupus
RF for RA, endocarditis, Hep C, cryoglobulinemia
Cutaneous vasculitis: initial treatment?
what are the long-term side effects of steroid usage?
-exogenous steroid shuts down your adrenal production, have to wean people off very slowly
-long term effects are osteoporosis, diabetes, weight gain
-also leads to skin thinning
Triggers for Raynaud's?
exposure to cold temps. even a small change like walking into AC or into the freezer section.
also stimulation of the sympathetic NS (being startled or upset).
what does Raynaud's present with?
color change in the fingers - may become white, red, or blue. may be painful and numb.
Patient may otherwise feel well.
What is the difference between primary and secondary Raynaud's? What is the age of onset for each?
Primary: occurs alone and not associted with another condition. Typically seen in females ages 15-30.
Secondary: secondary to another condition (often connective tissue disorders). Typically occurs after age 40.
What is nailfold capillary microscopy? How can it help us determine primary v secondary Raynaud's?
examination of the nailfold capillaries under a microscope.
With primary Raynaud's, the capillaries will look NORMAL. in secondary, the caps will look enlarged and distorted and will eventually drop out or hemorrhage.
In patients with Raymauds with dilated capilary loops, they are at higher risk of developing what kind of disease?
Odds ratio is 20 that they will eventualy develop a connective tissue disease
Your patient has abnormal-looking nailfold capillaries. What rheumatological conditions should you consider?
scleroderma, lupus, mixed connective tissue disease, dermatomyositis, polymyositis, Sjogren's, RA, vasculitis
what blood tests could you order to further evaluate a patient with Raynaud's?
CBC, CMP, Urinalysis, RF, ANA, ENA panel (may include some of these), C3, C4, Scl 70, Anti-centromere, Anti-RNA Polymerase III, anti-Ro and anti-La, U1RNP antibody
What can a patient with Raynaud's do in order to prevent attacks?
dress in layers to keep your core warm
avoid rapid changes in temp
hand and foot warmers
avoid some OTC cold meds, diet pills
may need to take meds to dilate vessels (sildenaphil).