Vasculopathic Reaction Pattern

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Dr Sampurna Roy MD

http://www.histopathology-india.net/dermpath.htm

The six major groups of vascular diseases are as follows:

NON INFLAMMATORY PURPURA :
Senile Purpura
VASCULO-OCCLUSIVE DISEASE:
DIC ; Atrophie blanche ; Cryoglobulinemia ; Thrombotic thrombocytopenic purpura ; Thrombocythemia.
URTICARIA :
ACUTE VASCULITIS :
NEUTROPHILIC DERMATOSIS : Sweet's syndrome; Rheumatoid neutrophilic dermatosis ; Behcet's disease. MISCELLANEOUS :

Vasculitis refers to a heterogeneous group of disorders in which there is inflammation and damage of blood vessel walls. The lesion may be limited to the skin or some other organ or be a mutisystem disorder .

Classification of vasculitis based on pathogenesis:

Direct Infection: Bacterial ; Rickettsial ; Mycobacterial; Spirochetal ; Fungal ( eg. mucormycosis); Viral (eg herpes)

Immunological injury:

Immune Complex Mediated: Henoch-Schonlein purpura ; Cryoglobulinemic vasculitis ; Drug induced vasculitis; Lupus vasculitis; Rheumatoid vasculitis ; Serum Sickness vasculitis; Infection -induced immune complex vasculitis ; i)Viral (eg. hepatitis B and C virus) ii) Bacterial (eg. Streptococcal) ; Erythema elevatum diutinumCLICK

Direct antibody mediated:

Antiendothelial cell antibody (AECA) -Kawasaki disease ; Lupus Vasculitis.

Antineutrophilic cytoplasmic antibody (ANCA) - Wegener's granulomatosis ; Microscopic polyangitis ; Churg-Strauss syndrome CLICK 1 ; 2 ; Some drug related vasculitis (eg thiouracil)

Cell-mediated: Allograph rejection

Unknown: Giant cell (temporal) arteritis ; Takayasu arteritis; Polyarteritis nodosa CLICK 1 ; 2; Granuloma faciale.

Chronic Lymphocytic Vasculitis: This is a number of clinically heterogeneous disease which on histopathological examination displays lymphocytic infiltrate involving and surrounding the small vessels in the dermis. There is associated endothelial swelling , extravasation of erythrocytes and extravasation of fibrin into vessel wall.

Eg.Toxic erythema ;Collagen vascular disease;Pityriasis LichenoidesCLICK ; Prurigo of pregnancy ; Pigmented purpuric dermatosis ; Perniosis ; Pyoderma Gangrenosum ; Rikettsial and viral infection ; Polymorphous Light EruptionCLICK

Vasculitis with Granulomatosis: Characterized by varying degrees of granulomatosis (angiocentric and unrelated to vessels) together with vasculitis.

Eg: Wegener's granulomatosis ; Lymphomatoid granulomatosis ; Allergic granulomatosis (Churg-Strauss syndrome), Midline granuloma and Temporal arteritis.

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