Polymorphic dermal angiitis is a chronic disease of recurrent dermatosis, which is caused by an inflammatory process of a non—specific type occurring in the walls of blood vessels. Such angiitis is expressed by various clinical manifestations: nodules, blisters, plaques, skin hemorrhage, blisters, swelling on the skin, necrosis, ulcers, scars and even ulcers. The main method of diagnosis of polymorphic dermal angiitis is dermatoscopy. As for treatment, it can include both the use of anti-inflammatory (or, for example, antihistamines) drugs, and the use of antibiotics, as well as glucocorticoids or drugs containing calcium (or delagil). In the case of a severe form of the disease, an extracorporeal method of blood purification is used for treatment.
The content of the article:
Types of polymorphic dermal angiitis
Symptoms of polymorphic dermal angiitis
Diagnosis of polymorphic dermal angiitis
Treatment of polymorphic dermal angiitis
Polymorphic dermal angiitis
Nowadays, dermatological studies are based on the immunocomplex theory regarding the occurrence and development of polymorphic dermal angiitis. The essence of this theory is that vascular damage directly depends on the effect of circulating immune complexes on them. Interestingly, antigens can be both local and general infections, including angina, SARS, streptococci, rubella and measles. In the case of polymorphic dermal angiitis, at the site of the lesion of the circulating immune complex, a thickening and bulging of the vascular walls forms, inside which undesirable nodules may appear. The walls are impregnated with fibrin, the permeability increases, which leads to hemorrhages. Necrosis of individual sections of the vascular walls or their compensatory overgrowth may also be observed.
Types of polymorphic dermal angiitis
Urticary
The urticary type of polymorphic dermal angiitis usually manifests itself on any part of the skin and can occupy a different-sized area, manifesting as blisters resembling urticaria. You can distinguish such rashes from urticaria by the absence of itching, as well as by the characteristic discomfort and painful sensations.
Hemorrhagic
If we talk about the hemorrhagic variant, it is the most common type of polymorphic dermal angiitis. Its characteristic feature is a focal intradermal hemorrhage, similar to one of the types of hemorrhagic purpura. Interestingly, Schenlein-Henoch disease is also a type of hemorrhagic type of polymorphic dermal angiitis, which, in addition to general symptoms, is also caused by abdominal pain and blood stools.
Papulonodular
The papulonodular type is the rarest and manifests itself as the appearance of compacted nodules and larger nodes (the size of a walnut), while without feeling any discomfort, but with the presence of painful sensations when feeling.
Papulonecrotic
The papulonecrotic type is characterized by the appearance of a small number of inflammatory nodules, inside of which various necrotic changes are observed after some time. As a result, a black crust forms, covering the bleeding ulcers. The healing process is accompanied by the formation of scars. Characteristic of papulonecrotic polymorphic dermal angiitis is localization on the extensor surface near the joints of the extremities. It should be remembered that this form of the disease is very similar to the papulonecrotic type of tuberculosis of the skin.
Pustular-ulcerative type
The pustular-ulcerative type of polymorphic dermal angiitis begins with the appearance of blistering formations or pustules on the skin (on any part of the body), which is very similar to acne or folliculitis. At the place where the rashes were found, the formation of deep ulcers can be observed, which increase in size over time. After healing, scars remain.
Necrotic-ulcerative
Another type of polymorphic dermal angiitis is necrotic-ulcerative type, which forms a special type of blood clots in the affected vessels, causing necrosis of both individual skin areas and the entire skin with further formation of a black scab. This type of disease is characterized by a severe course with a sudden onset and a sharp deterioration in the general condition of the patient, which can lead to a fatal outcome. Even if the patient does not die, hard-healing ulcers form on the affected areas of the skin, which are very difficult to treat.
Symptoms of polymorphic dermal angiitis
As is known, polymorphic dermal angiitis occurs with a characteristic lesion of the shin skin. But it also happens that another part of the body becomes the localization of rashes. In some cases, the appearance of such skin elements may be preceded by characteristic symptoms, including weakness, fever, excessive fatigue, headache, arthralgia, etc. It should be said that the rashes that have arisen on the skin can last for several months. When the rash heals completely, the impression of a final recovery of the patient may arise, however, it should be remembered that there is always a risk of relapse. Depending on which of the elements of the rash prevails, we can talk about the existence of different types of polymorphic dermal angiitis.
Diagnosis of polymorphic dermal angiitis
The main diagnostic method that a dermatologist uses to make a diagnosis is dermatoscopy. This study makes it possible to detect the inflammatory process taking place in the walls of blood vessels, as well as possible impregnation with fibrin, thrombosis, all kinds of necrotic changes or the exit of blood cells beyond the boundaries of blood vessels.
Treatment of polymorphic dermal angiitis
The best treatment for polymorphic dermal angiitis is the use of anti—inflammatory drugs, including butadione or indomethacin. In addition, various antihistamines are used (for example, suprastin or desloratadine), vitamins P and C, as well as preparations containing calcium. In case of infection occurring against the background of polymorphic dermal angiitis, doctors prescribe antibiotic therapy. In more severe cases, glucocorticosteroid therapy is used, as well as various methods of extracorporeal hemocorrection, including plasmapheresis or cryoaferesis. In the case of a recurrent course, a longer course of delagil is usually prescribed. For the local treatment of polymorphic dermal angiitis, bandages with corticosteroids are used, as well as ointments of Flucinar or Photocort.
