Livedo vasculopathy (LV), czyli waskulopatia sinicza, to schorzenie naczyń o przewlekłym, nawracającym, niezapalnym charakterze. Zmiany chorobowe obejmują dystalne części kończyn dolnych. LV może stanowić jedną z rzadkich przyczyn trudno gojących się ran.
Patofizjologia LV
Patogeneza waskulopatii siniczej nie została w pełni rozpoznana. W literaturze naukowej rozwój choroby jest często wiązany ze stanami nadkrzepliwości. U chorych stwierdza się zaburzenia funkcji płytek krwi, osoczowych czynników krzepnięcia oraz fibrynolizy. Prowadzi to do tworzenia się zakrzepów w tętniczkach skóry dystalnych części kończyn dolnych.
Waskulopatia sinicza a trudno gojące się rany
W obrazie klinicznym waskulopatii siniczej obserwuje się sine lub czerwone plamy i grudki z towarzyszącą teleangiektazją, które następnie przekształcają się w owrzodzenia o niewielkich rozmiarach i nieregularnych kształtach. Zmiany chorobowe najczęściej obejmują dystalne części obu kończyn dolnych i wywołują silne dolegliwości bólowe. Goją się z pozostawieniem białych, gwiaździstych blizn (fr. atrophie blanche).
U części pacjentów występują ponadto takie objawy jak siność siatkowata, objaw Raynauda czy akrocyjanoza.
Waskulopatię siniczą diagnozuje się najczęściej wśród kobiet w średnim wieku, jednak przypadki choroby stwierdzano również we wszystkich pozostałych grupach wiekowych, także wśród dzieci. Zwiększona zachorowalność na LV jest odnotowywana w miesiącach letnich oraz podczas ciąży.
Rozpoznanie i leczenie waskulopatii siniczej
Rozpoznanie choroby następuje w wyniku badania histopatologicznego, które wykazuje proliferację śródbłonka, odcinkowe zeszkliwienie ścian naczyń oraz zablokowanie naczyń przez złogi włóknika. W diagnostyce waskulopatii siniczej wykorzystuje się również metodę bezpośredniej fluorescencji.
Nie istnieje obecnie powszechnie zatwierdzona metoda leczenia waskulopatii siniczej. W literaturze naukowej znajdują się wzmianki o stosowaniu ze zróżnicowanym powodzeniem m.in. leków przeciwzapalnych, przeciwzakrzepowych i przeciwpłytkowych oraz terapii tlenem hiperbarycznym.
W leczeniu zmian skórnych w przebiegu LV stosuje się standardowe procedury postępowania z ranami trudno gojącymi się. Specjaliści zalecają postępowanie zgodne ze strategią TIME.
Źródło: Isoherranen K, Jordan O’Brien J, Barker J et al. EWMA document; Atypical wounds. Best clinical practice and challenges
Przeczytaj także: Co to jest rana i jak powinien przebiegać proces gojenia?
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