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Vol. 103. Issue 3.
Pages 179-191 (April 2012)
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Vol. 103. Issue 3.
Pages 179-191 (April 2012)
Review
DOI: 10.1016/j.adengl.2011.06.001
Cutaneous Vasculitis
Vasculitis cutáneas
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A. Pulido-Pérez, J.A. Avilés-Izquierdo, R. Suárez-Fernández
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Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Table 1. Classification of Vasculitides.
Table 2. Histopathologic Criteria in the Diagnosis of Vasculitis.
Table 3. Etiology of Cutaneous Small Vessel Leukocytoclastic Vasculitis.a
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Abstract

Vasculitis is a term that refers to damage and inflammation of the walls of blood vessels of any size. The classification of types of cutaneous vasculitis continues to be a challenge, probably because of our lack of understanding of the etiology and pathogenesis of this condition. Changes in the vessel wall will be visible on microscopy and will enable the different clinical forms to be distinguished according to the caliber of affected vessels, the type of cell that predominates in the inflammatory infiltrate, or the presence of such key findings as extravascular granulomas. Skin manifestations (macules, papules, nodules, livedo reticularis, etc.) correlate with the size of the vessel affected. The prognosis in cases of vasculitis with skin involvement will be determined by the presence or absence of extracutaneous disease. Systemic vasculitis shows a predilection for certain organs, such as the kidney or lung. The introduction of immunosuppressant drug treatments has led to evident improvement in survival rates for patients with vasculitis. This review covers practical aspects of the pathophysiology, histopathology, treatment, and differential diagnosis of the main clinical presentations of vasculitis with cutaneous involvement.

Keywords:
Vasculitis
Purpura
Skin biopsy
Resumen

El término vasculitis define el daño e inflamación de las paredes vasculares, con independencia del calibre del vaso afectado. Clasificar las vasculitis con afectación cutánea constituye un reto aún no superado, como consecuencia, probablemente, de la falta de conocimiento sobre su etiopatogenia. En la microscopía deben encontrarse datos de afectación de la pared vascular, diferenciándose unos cuadros de otros por el calibre del vaso afectado, el tipo celular predominante en el infiltrado inflamatorio o la presencia de hallazgos característicos, como los granulomas extravasculares. En la clínica existe una correlación entre los hallazgos cutáneos (máculas, pápulas, nódulos, livedo reticular…) y el calibre del vaso afectado. El pronóstico de las vasculitis con afectación cutánea viene determinado por la presencia o no de compromiso extracutáneo, de forma que las vasculitis sistémicas muestran especial predilección por órganos como el riñón o el pulmón. No obstante, tras la introducción de los fármacos inmunosupresores la supervivencia de estos pacientes ha experimentado un cambio ostensible. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, histopatología, tratamiento y diagnóstico diferencial de los principales cuadros vasculíticos con afectación cutánea.

Palabras clave:
Vasculitis
Púrpura
Biopsia cutánea

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