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Leukocytoklastyczne zapalenie naczyń przyczyną zmian martwiczych i owrzodzeń

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Leukocytoklastyczne zapalenie naczyń to rzadkie schorzenie, które może wywoływać zmiany skórne o zróżnicowanym obrazie klinicznym. Występuje jako samodzielna choroba lub powikłanie innych schorzeń. Jak objawia się leukocytoklastyczne zapalenie naczyń i jak je leczyć?

Leukocytoklastyczne zapalenie naczyń, nazywane również zapaleniem naczyń z nadwrażliwości, to schorzenie o nie w pełni rozpoznanej etiologii. Zalicza się do grupy układowych zapaleń naczyń związanych z nadwrażliwością na antygeny (zarówno egzogenne, jak i endogenne).

Czynnikami wywołującymi chorobę mogą być leki, substancje chemiczne i pokarmowe, zakażenia bakteryjne, wirusowe, grzybicze lub pasożytnicze, inne choroby układowe tkanki łącznej, a także antygeny nowotworowe lub DNA. Indukcja choroby może być również związana z obcym białkiem (choroba posurowicza) lub ukąszeniem owada. Znaczna część przypadków określana jest jako idiopatyczna

Leukocytoklastyczne zapalenie naczyń może być również związane z innymi typami zapaleń naczyń, w przebiegu których dochodzi do zajęcia skóry. Zalicza się do nich m.in. ziarniniakowatość Wegenera, rumień wysiękowy wielopostaciowy, rumień wyniosły przetrwały oraz sarkoidozę

Patogeneza leukocytoklastycznego zapalenia naczyń

W przebiegu choroby dochodzi do zapalenia małych naczyń w wyniku odkładania się w ich ścianach kompleksów immunologicznych antygen-przeciwciało. W następstwie dochodzi do uszkodzenia ścian naczyń krwionośnych i niedokrwienia tkanek, co wywołuje objawy skórne i może również doprowadzić do zajęcia narządów wewnętrznych. 

Objawy skórne w przebiegu leukocytoklastycznego zapalenia naczyń

Leukocytoklastyczne zapalenie naczyń może wywoływać zróżnicowane objawy skórne. Różne typy zmian skórnych mogą następować jedne po drugich lub współistnieć od początku procesu chorobowego. Mogą również ulegać szybkiej ewolucji i rozprzestrzeniać się. 

Zmiany skórne, które mogą wystąpić w przebiegu leukocytoklastycznego zapalenia naczyń, to:

  • krwotoczne zmiany plamicze różnej wielkości, wyczuwalne palpacyjnie; nie bledną pod wpływem ucisku;
  • krwotoczne grudki i guzki z występującą w centralnej części martwicą
  • wykwity rumieniowe, obrzękowe, pokrzywkowe;
  • siateczkowate poszerzenie naczyń skóry;
  • pęcherze z tendencją do powierzchownego rozpadu; 
  • owrzodzenia

U osób chodzących zmiany skórne występują najczęściej w obrębie kończyn dolnych, natomiast u pacjentów leżących zmiany chorobowe pojawiają się najczęściej w okolicy krzyżowej. 

Zmiany goją się z towarzyszącym bliznowaceniem. Mogą mieć charakter ostry, podostry lub przewlekły

Leczenie leukocytoklastycznego zapalenia naczyń

W terapii leukocytoklastycznego zapalenia naczyń stosuje się małe dawki kortykosteroidów, leków przeciwhistaminowych oraz przeciwzapalnych. W przypadkach spowodowanych czynnikami egzogennymi istotne jest ich wyeliminowanie. 

Źródło:

D. Sikorska, R. Marcinkowska-Pięta i in., “Leukocytoklastyczne zapalenie naczyń indukowane leczeniem biologicznym – opis przypadku i przegląd piśmiennictwa”, Forum Reumatol. 2017, tom 3, nr 3, 181–183.

J. Roszkiewicz, M. Lange i in., “Alergiczne lub leukocytoklastyczne zapalenie naczyń”, Forum Medycyny Rodzinnej 2007, tom 1, nr 3, 272–279.

 

Przeczytaj także: Terapia komórkami macierzystymi skuteczna przeciwko zakażeniom MRSA

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