The spectrum of clinical vasculitis-related lesions is wide and includes erythema, purpura, papules, pustules, nodules, livedo, necrosis, ulcerations and/or bullae. These different lesions are often associated, giving rise to a pleomorphic clinical picture, that is not specific to any of the systemic vasculitides, granulomatous or otherwise.
Palpable purpura and petechiae are unquestionably the most frequent manifestations (Figs. 1 and 2). Lesions usually begin as tiny red macules that later become papules and plaques ranging from few millimeters to several centimeters in diameter. The larger lesions are more often ecchymotic than purpuric. They are predominantly localized on legs, ankles and feet but may occur on any part of the body, especially areas subjected to local mechanical pressure.
Cutaneous nodules due to vasculitis are typically warm, tender, red and small; they may be surrounded by livedo reticularis. Like livedo, they are mainly localized on the lower limbs (legs, soles) but are also frequently seen in other sites, such as the dorsal face of the arms or more rarely on the trunk. They may occur in clusters along the superficial arteries.
Livedo reticularis is a reddish blue mottling of the skin in a 'fishnet' reticular pattern, typically
irregular with broken circles (Fig. 3). When associated with vasculitis, it is persistent, although some fluctuations in intensity and extent may be observed, especially with variations of temperature. On careful examination, some infiltrated areas may often be detected.
Urticarial vasculitis is characterized by the presence of wheals, which persist for 2-3 days, unlike ordinary urticaria that disappear within 24 h. Pruritus is less intense. Urticaria may evolve into purpuric lesions. They are mainly localized on the trunk and the limbs. Some of them may have a chronic evolution, resembling erythema elevatum diutinum.
Skin purpuric necrosis might occur as the consequence of dermal vessel obstruction (Fig. 4). Its extension and depth are highly variable depending on the type, size and location of affected vessels. Localized purpuric and necrotic lesions may evolve into vesicles and then into pustules, due to superinfection. When necrosis is extensive, painful purpura is followed by black necrotic plaque formation with active purpuric edges and bullous lesions. After removal of necrotic tissue, ulcerations of various sizes are usually present and may take a long time to heal, often leaving large scars.
Pustular vasculitis is another possibility but less frequent, non-follicular, with underlying erythema and usually results from secondary infection of necrotic lesions.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.