Vasculitis Images: 6 Key Clinical Photos To Aid Diagnosis
Comprehensive visual guide to cutaneous and systemic vasculitis manifestations in dermatology practice.
Vasculitis refers to inflammation of blood vessels, which can affect capillaries, venules, arterioles, or larger arteries in the skin and systemic organs. Cutaneous manifestations often present as
palpable purpura
, urticarial plaques, nodules, ulcers, or livedo reticularis. This image gallery illustrates key types of vasculitis, aiding in clinical diagnosis and differentiation.What is vasculitis?
Vasculitis encompasses a spectrum of disorders characterized by blood vessel wall inflammation, leading to damage in the skin or multiple organs. Small vessel vasculitis, the most common cutaneous form, involves post-capillary venules and presents with palpable purpura—raised, non-blanching haemorrhagic lesions typically on the lower legs. Larger vessel involvement, as in polyarteritis nodosa, may cause nodules or ulcers. Immune complex deposition, infections, drugs, or autoimmune triggers often underlie these conditions.
Systemic vasculitis can involve kidneys, joints, nerves, or gastrointestinal tract, necessitating prompt evaluation. Histopathology typically reveals leukocytoclastic vasculitis (neutrophilic infiltration, fibrinoid necrosis, red cell extravasation) in small vessel forms.
Clinical features of cutaneous vasculitis
Skin lesions vary by vessel size and aetiology:
- Palpable purpura: Classic hallmark; red-purple macules, papules, or plaques on legs, buttocks, thighs. Lesions may blister, ulcerate, or resolve with hyperpigmentation.
- Urticarial plaques: Oedematous, hive-like but persistent >24 hours, often burning rather than itching.
- Nodules and ulcers: In medium vessel vasculitis like cutaneous PAN; tender subcutaneous nodules along vessels, chronic leg ulcers.
- Livedo reticularis: Mottled, net-like pattern from arteriolar involvement.
- Exercise-induced: Purpura on calves/thighs post-strenuous activity in heat; asymptomatic, self-resolving.
Onset is often acute after triggers like drugs (antibiotics, NSAIDs), infections (streptococcal, viral), or idiopathic. Lesions last 1-4 weeks but may recur. Systemic symptoms (fever, arthralgia, myalgia) suggest broader involvement.
Types of cutaneous vasculitis
Cutaneous vasculitis classifies by vessel size and mechanism:
Small vessel vasculitis (hypersensitivity vasculitis)
Most common; immune complex-mediated, affecting post-capillary venules. Triggers: drugs (10-20% cases), infections, autoimmune diseases. Features palpable purpura ± systemic signs (nephritis in Henoch-Schönlein purpura).
Urticarial vasculitis
Hive-like lesions lasting days, resolving with purpura. Associated with hypocomplementaemia, SLE, or hepatitis. Biopsy shows leukocytoclastic vasculitis.
Exercise-induced vasculitis (golfer’s vasculitis)
Benign capillaritis post-exercise in warm weather; purpuric patches on lower legs. Due to venous stasis and heat.
Cutaneous polyarteritis nodosa (PAN)
Medium vessel; subcutaneous nodules, livedo, ulcers on legs. Rarely systemic; relapsing course.
ANCA-associated (e.g., granulomatosis with polyangiitis)
p-ANCA positive; purpura with systemic features like renal failure.
Differential diagnosis
| Condition | Key Features | Differentiator |
|---|---|---|
| Non-palpable purpura | Thrombocytopenic, coagulopathy | Platelets normal; lesions blanch/non-raised |
| Infective emboli | Splinter haemorrhages, fever | Cultures/biopsy show organisms |
| Pigmented purpuric dermatoses | Chronic cayenne pepper spots | No inflammation on biopsy |
| Sweet syndrome | Painful plaques, fever | Dense neutrophilic infiltrate sans vasculitis |
| Pyoderma gangrenosum | Rapid ulcers with undermined edges | Neutrophilic dermatosis, pathergy |
Diagnosis
Clinical pattern guides biopsy (4mm punch of early lesion): leukocytoclastic vasculitis confirms small vessel type; immunofluorescence shows immune deposits. Investigations for systemic disease:
- Bloods: FBC, U&E, LFT, CRP/ESR, ANCA, ANA, cryoglobulins, hepatitis serology.
- Urine: Dipstick/protein:creatinine ratio for glomerulonephritis.
- Other: ECG, CXR, USG if indicated.
Skin biopsy is gold standard, showing vessel wall neutrophils, karyorrhexis, fibrin.
Treatment
Tailored to severity and cause:
- Mild cutaneous: Rest, leg elevation, compression stockings, topical steroids, NSAIDs.
- Symptomatic: Oral colchicine, dapsone, hydroxychloroquine.
- Severe/systemic: Prednisone 0.5-1mg/kg, ± immunosuppressants (azathioprine, cyclophosphamide, rituximab).
- Exercise-induced: Avoidance of triggers; self-limits in 3-4 weeks.
Remove triggers (drugs, infections). Prognosis excellent for skin-limited (resolves weeks-months); monitor for systemic progression.
Frequently Asked Questions (FAQs)
What causes vasculitis skin rashes?
Cutaneous vasculitis often stems from immune complexes triggered by infections, medications (e.g., penicillin, NSAIDs), autoimmune conditions, or idiopathic factors. About 50% cases have no identifiable cause.
Is cutaneous vasculitis dangerous?
Skin-limited forms are benign and self-resolving. Systemic involvement (kidney, nerves) requires urgent treatment to prevent organ damage.
How long do vasculitis lesions last?
Individual lesions fade in 1-4 weeks, but new crops may appear for months. Post-inflammatory pigmentation can persist longer.
Can vasculitis recur?
Yes, especially if triggers persist. Exercise-induced recurs with activity in heat; hypersensitivity with re-exposure.
Does vasculitis affect children?
Rare; Henoch-Schönlein purpura is common paediatric small vessel vasculitis, often post-infection with IgA deposits.
Image Gallery: Vasculitis Lesions
This section showcases representative images (descriptions based on common presentations):
- Palpable purpura on legs: Multiple red-purple papules coalescing on ankles/lower legs; classic hypersensitivity vasculitis.
- Urticarial vasculitis: Annular erythematous plaques with central purpura on trunk; persistent >24h.
- Exercise-induced purpura: Reticular purpura on calves post-golfing; resolves spontaneously.
- Cutaneous PAN nodules: Tender violaceous subcutaneous nodules along shin vessels.
- Livedo reticularis with ulcers: Mottled netting with punched-out leg ulcers in medium vessel disease.
- Henoch-Schönlein purpura: Palpable purpura on buttocks/thighs in child; ± arthritis, haematuria.
These visuals highlight diagnostic morphology for clinicians. Always correlate with history and biopsy.
Understanding vasculitis through images enhances recognition of subtle variants, from benign exercise-induced to ominous systemic forms. Early intervention improves outcomes.
References
- Cutaneous signs of systemic disease. Cutaneous vasculitis – DermNet — DermNet NZ. 2009 (updated). https://dermnetnz.org/cme/systemic/cutaneous-vasculitis-cme
- Cutaneous small vessel vasculitis – DermNet — DermNet NZ. https://dermnetnz.org/topics/cutaneous-small-vessel-vasculitis
- Vasculitis (Causes, Symptoms, and Treatment) – Patient.info — Patient.info. https://patient.info/doctor/dermatology/vasculitis-pro
- Cutaneous Vasculitis: Classification, Causes, and Features – DermNet — DermNet NZ. https://dermnetnz.org/topics/cutaneous-vasculitis
- Exercise-induced vasculitis – DermNet — DermNet NZ. https://dermnetnz.org/topics/exercise-induced-vasculitis
- Cutaneous polyarteritis nodosa – DermNet — DermNet NZ. https://dermnetnz.org/topics/cutaneous-polyarteritis-nodosa
- Vasculitis – StatPearls – NCBI Bookshelf — NCBI/NIH. 2023. https://www.ncbi.nlm.nih.gov/books/NBK545186/
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