Rheumatologie: Aktuelle Forschung
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Importance of Cutaneous Vasculitis in Rheumatology

Ko-Ron Chen

Cutaneous vasculitis may present as a significant component of many systemic vasculitic syndromes such as rheumatoid vasculitis or anti-neutrophil cytoplasmic antibody (ANCA) associated primary vasculitic syndromes like microscopic polyangiits. Cutaneous vasculitis manifested most often as palpable purpura or infiltrated erythema indicating dermal small vessel vasculitis and less commonly as nodular erythema, livedo reticularis, deep ulcers or digital gangrene suggesting subcutaneous muscular vessel vasculitis.Coexistence of dermal small vessel vasculitis and subcutaneous muscular vessel vasculitis usually indicated systemic vasculitis such as connective tissue disease (CTD)-associated vasculitis, ANCA associated vasculitis. Behcet’s disease, polyarteiritsnodosa, Cogan’s syndrome, and malignancy associated. An appropriate lesional skin biopsy is the key to obtaining the diagnosis. Treatment for cutaneous vasculitis should include devoid of the triggers (excessive standing, infection, drugs) and exclusion of vasculitis-like syndromes (psudovasculitis). In most instances, cutaneous vasculitis represents a self-limited condition and will be relieved by leg elevation, avoidance of standing and therapy with non-steroidal antiinflammatory drugs.For mild recurrent or persistent disease, colchicine and daps one are first-choice agents. Severe cutaneous and systemic disease requires more potent immunosuppression (prednisone plus azathioprine, methotrexate, cyclophosphamide).The new biologic therapies that work via cytokine blockade or lymphocyte depletion such as tissue necrosis factor-inhibitor infliximab and the anti-B cell antibody rituximab, respectively, are showing benefit in certain settings such as CTD and ANCA associated vasculitis. Rheumatologists who are familiar with the complicated clinical and histopathological spectrum of cutaneous vasculitis and correlation of systemic vasculitis as well as the technique of skin biopsy will make the diagnosis earlier in vasculitis syndromes with skin involvement.