Hypersensitivity vasculitis is an inflammation of the skin vessels. The triggers may be drugs or infections to which the immune system overreacts in the sense of an allergy. The disease can spread from the skin to internal organs. Serious bodily damage then threatens as a result of hypersensitivity vasculitis.
What is hypersensitivity vasculitis?
Hypersensitivity vasculitis is an inflammatory disease of the blood vessels. By definition, what many forms of vasculitis have in common is that an autoimmune reaction underlies or is involved. This involves an attack by the immune system on the body’s own tissues. Thus, the vasculitides in their manifestation belong to the rheumatic group of forms. Vasculitides are divided into:
1. cutaneous vasculitides, in which only the vessels of the skin are affected and
2. systemic vasculitides, in which vessels of internal organs also show the inflammatory symptoms. A further classification is made according to the size of the diseased vessels. One form of cutaneous vasculitis with inflammation of small skin vessels is hypersensitivity vasculitis.
Causes
Hypersensitivity vasculitis is characterized by deposits of protein complexes on the walls of skin vessels. These protein deposits result from an immune response. Initially, the immune system produces specific immunoglobulins (antibodies) that bind with other proteins. These proteins are called antigens and are the trigger for the immune response. Antigens in the context of hypersensitivity vasculitis are once exogenous (foreign to the body) factors. These can be viral or bacterial infections or drugs. On the other hand, endogenous (body’s own) triggers may be involved in the biochemical cascade. Why the immune system, which is otherwise directed exclusively against foreign particles, suddenly attacks the body’s own components is currently unknown. An inflammatory reaction results in any case when an antigen is bound by an antibody. Autoimmune reactions are usually a contributing cause of hypersensitivity vasculitis.
Symptoms,, complaints, and signs
Hypersensitivity vasculitis is typically characterized by small hemorrhages in the skin. Intense red dot-like spots form that can be up to three millimeters in size. After a few days, these spots change color from red to blue-red. Initially, they appear only on the lower legs. As the disease progresses, new punctate hemorrhages form parallel to the darkening spots and may extend from the lower legs to the upper legs. The spots are usually symptom-free. Only in some cases do they burn or itch. In more severe inflammations, they turn dark red and expand in diameter to several millimeters. In particularly severe cases, the upper skin layer (epidermis) may also die in the center of the spots. The dead epidermis turns light gray or forms blisters. In even more severe cases, even the connective tissue-like dermis dies, leaving behind black nodules. After their detachment, small painful ulcers develop. As a rule, vascular inflammation appears suddenly. However, it also regresses within a few weeks and heals with the formation of brown spots. However, the inflammation can always recur. Sometimes the joints, gastrointestinal tract or kidneys are also affected. Thus, hypersensitivity vasculitis may occasionally be dressed by swelling of the joints, mild intestinal bleeding, or usually mild inflammation of the kidneys.
Diagnosis and course
Hypersensitivity vasculitis begins with blue-purple mottled areas of skin that spread from the ends of the extremities toward the center of the body. This skin pattern results in a typical picture with many small spots and larger spots in between. The bluish tint results from circulatory disturbances in the irritated and constricted vessels. The dermatologist will recognize hypersensitivity vasculitis just from this. Symptoms may be accompanied by itching or pain, but this is the case in relatively few patients. As the disease progresses, areas of skin may die (necrosis). Diagnostically, a blood laboratory is now required that specifically focuses on the immunological findings. In particular, the rheumatoid factors must also be taken into account. Top priority is also given to the search for involvement of internal organs.Therefore, clinical examinations with radiographic methods, for example, are also part of the diagnosis of hypersensitivity vasculitis.
Complications
Hypersensitivity vasculitis results in various complaints. These usually depend on the severity of the disease. If hypersensitivity vasculitis does not work treated, it can cause damage to the internal organs, which can also lead to death. The affected person suffers from discoloration of the skin due to the disease. This usually turns blue and is covered with spots. Bleeding also occurs on the skin and the skin is covered with blisters. It is not uncommon for the muscles and joints to also ache, which leads to difficulties in everyday life and limited movement for many patients. Furthermore, patients suffer from decreased exercise tolerance and fever. The patient feels tired and fatigued and no longer actively participates in life due to hypersensitivity vasculitis. Treatment of hypersensitivity vasculitis takes place with the help of medications and various therapies. In this process, there are no further complications. However, a positive course of the disease cannot be guaranteed in every case. In many cases, ointments and creams can also be used to relieve pain.
When should you go to the doctor?
Because hypersensitivity vasculitis is a condition that requires treatment, a doctor must be consulted as soon as unusual changes in the skin’s appearance become apparent. If blistering and discoloration of the skin occur, a doctor is needed. If swellings form, or if there is pain in the joints or muscles, a doctor should clarify the symptoms. If there is a loss of the usual level of strength, fatigue, internal weakness or a general feeling of malaise, a doctor should be consulted. Further examinations are necessary if there are repeated bleedings or wheals on the skin. Palpable small blotchy areas on the body are signs of a disease that requires medical treatment. Persistent itching and heavy legs should also be examined by a doctor. If open wounds form, sterile wound care must be provided. A visit to the doctor is necessary as soon as inflammation, fever or the development of pus occurs. If the skin changes spread over the body or emotional problems arise, a doctor should be consulted. In case of circulatory problems, a doctor should be consulted immediately. There is a threat of further illness as well as a life-threatening condition if treatment is not received. Sensitivity disorders, numbness as well as tingling in the limbs are warning signs of the body. They require medical evaluation to determine the cause.
Treatment and therapy
Hypersensitivity vasculitis proves therapeutic as a search for the trigger of the immunologic overreaction. Exogenous factors can be eliminated by the physician, so infections can be treated with antibiotics if necessary. If the side effect of a drug is present, the physician must change the medication. Alleviating symptoms is the second pillar of therapy. Thus, in many cases, bed rest is indicated, and the legs are best elevated, because this is where skin changes are usually most serious. In addition, patients wear compression stockings. Cortisone-like preparations can be used to suppress the inflammatory reactions. The pharmaceuticals are either applied as ointments or given as tablets. Oral administration is more common in severe cases where skin necrosis is already present. In addition, physicians have also achieved success with colchicine in the treatment of hypersensitivity vasculitis. The substance from the meadow saffron acts like a cytostatic. Possible drug therapy also includes immunosuppressants, i.e. agents that reduce immunological activity. If, in addition to the skin, internal organs are also affected, the dermatologist will consult colleagues in appropriate specialties. Otherwise, permanent organ damage is a possible consequence of hypersensitivity vasculitis.
Outlook and prognosis
The prognosis of hypersensitivity vasculitis is favorable. Because the symptoms are triggered by the administration of certain medications, relief can be achieved if the treatment plan devised is modified and optimized. The existing underlying disease is further treated in these patients by an alternative treatment method.If the triggering drugs of hypersensitivity vasculitis are discontinued, the state of health usually improves within a few hours. With the removal of the active substances from the organism, the symptoms are minimized. Normally, after a few days, freedom from the symptoms that have occurred is documented. However, in rare cases, an unfavorable prognosis may occur. If the triggers of hypersensitivity vasculitis are not found as soon as possible or if the patient does not contact the attending physician to discuss the worsening of his health condition, an acute situation is imminent. This can be potentially life-threatening. If damage to the organs occurs, organ failure may occur in addition to dysfunction. This increases the risk of premature death of the patient. The healing process is particularly difficult if hypersensitivity vasculitis is not recognized. With a gradual increase in symptoms, finding the cause of the symptoms is often made more difficult. This increases the likelihood of permanent damage and increases the risk of mortality.
Prevention
Preventing hypersensitivity vasculitis is difficult because the body’s complex reactions to drugs or other chemicals are virtually impossible to predict. Allergy sufferers should keep a vigilant watch on their bodies and also be very sensitive to their general condition. Skin changes in particular should give cause for a visit to the doctor. For it is especially there that the obvious symptoms of hypersensitivity vasculitis show themselves.
Follow-up
Treatment of hypersensitivity vasculitis entails a recovery period. Thus, follow-up care usually begins with bed rest with the legs elevated to relieve the skin lesions. The physician often prescribes compression stockings; furthermore, cortisone-like preparations are helpful against the typical inflammatory reactions. As part of the drug therapy, patients receive immunosuppressants, which they must take exactly as recommended by the doctor. If there is damage to the internal organs, further specialist consultation may be required. The body’s overreactions to certain drugs and chemicals cannot always be predicted. For this reason, there are few blanket preventive measures for those affected. Allergy sufferers should keep a close eye on their state of health to detect any changes as soon as possible. The increased sensitivity helps to react quickly and to make a doctor’s appointment at short notice. Skin changes in particular can be an indication of the disease. To prevent the skin from becoming further inflamed and the already existing irritations from becoming more severe, it is best for patients to avoid cosmetics completely. The doctor will give them useful advice on thorough and careful hygiene, which they should follow exactly. For a speedy improvement and for the stabilization of the immune defense, it is helpful to refrain from alcohol during the illness.
This is what you can do yourself
Due to the potential complications of hypersensitivity vasculitis, it is significant for the sufferer to strictly follow the doctor’s instructions. Usually, the specialist prescribes rest or even bed rest. In addition, the patient often takes various medications to reduce the discomfort caused by hypersensitivity vasculitis. Since hypersensitivity vasculitis is sometimes caused by medications, additional medications are not to be taken under any circumstances unless specifically prescribed by the physician. Patients with hypersensitivity vasculitis at best allow themselves time off from their daily obligations to facilitate regeneration of the attacked organism and to observe their own health condition more closely. Particularly after taking medication, attention should be paid to whether further side effects develop. In such cases, patients with hypersensitivity vasculitis immediately contact the appropriate medical professional. In general, it is important for the success of the treatment of hypersensitivity vasculitis that the patient undergoes close monitoring examinations by the physician. In order not to provoke further inflammations of the skin and not to aggravate the existing ones, patients avoid cosmetics as much as possible during hypersensitivity vasculitis. Thorough personal hygiene coordinated with the doctor is nevertheless essential.In addition, to support the body’s defenses, ill persons refrain from consuming alcohol during the period of illness.