Livedo reticularis and livedoid vasculitis

Introduction to reticular leukoplakia and leukoplakia The reticular leukoplakia and livedoreticularisandlivedovasculitis are vascular diseases in which the skin is blue-violet-like in a variety of factors, which can be aggravated by cold. When persistent functional vascular changes develop into organic lesions, they become plaque vasculitis. basic knowledge The proportion of illness: 0.004%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: Hypertension Pancreatitis Lymphoma

Causes of reticular leukoplakia and leukoplakia vasculitis

(1) Causes of the disease

There are many reasons for causing reticular leucoma and livedo vasculitis. Because of different reasons, the shape is different. If some are completely reticular, some are grape-like, diffuse arteries. Increased lesions and blood viscosity produce diffuse skin changes, and localized arterial lesions produce localized skin changes.

(two) pathogenesis

The microcirculatory structure of normal skin is formed by a shallow plexus (under the nipple capillary sputum) and a deep plexus (the arterioles and venules under the reticular layer) parallel to the surface of the skin and a communication branch perpendicular thereto. When the vertical arterioles are paralyzed for some reason, the capillaries and venules of the superficial plexus are dilated and congested, and the blood flow is slower than the blood vessels interlaced therebetween, so that blue-purple reticular skin changes appear on the skin. .

Tissue lesions vary with the disease stage, involving the fine arteries, capillaries and venules, and the lesions of the arterioles are prominent; the endothelial cells are swollen, the proliferation becomes arterial endometritis, fibrin deposition in the wall, and transparent thrombosis in the lumen There are a few neutrophils and nuclear dust in the wall and surrounding tissues, as well as infiltration of lymphocytes and histiocytes, dermal papillary edema, red blood cell overflow, epidermal cell and intracellular edema, blister formation and necrosis, and luminal infarction ulcer.

Reticular plaque and plaque prevention

Pay attention to cold and warm, avoid emotional factors, avoid smoking, prevent local trauma, avoid low temperature work, secondary patients should treat their primary disease as much as possible.

Reticular plaque and plaque vasculitis complications Complications Hypertensive pancreatitis lymphoma

Some patients with primary reticular bluish with high blood pressure, a small number of patients with brain, heart and peripheral vascular disease, can also be associated with systemic vascular disease, secondary reticular leukoplakia can be complicated: 1 connective tissue disease 2 vascular disease; 3 blood diseases; 4 chronic infectious diseases; 5 pancreatitis, hyperparathyroidism, lymphoma.

Reticular leukoplakia and leukocytitis symptoms Common symptoms Hemorrhagic papules, vesicles, frostbite, nodular nodules, reticular plaque edema, varicose veins

1. Functional vascular changes

(1) Marble skin: usually occurs in normal infants and young women's lower limbs and trunk, which is a physiological response of skin blood vessels to cold stimulation. Due to the cold, the skin vasoconstriction, the vein short circuit is open, the venous pressure is increased or the blood viscosity is increased, the blood flow is slow, and the skin has a blue-violet reticular change. The lesions are more diffuse, but to a lesser extent, often without self-conscious symptoms, disappearing spontaneously after warming, generally not associated with other diseases, but sometimes accompanied by frostbite, cyanosis and red sputum, severe skin and skin reticulation The bleu is not easy to distinguish.

(2) livedo racemosa: the vein branches of the dilated blood are irregular dendritic or grape-like dark red patches, whose edges gradually disappear into normal skin, causing skin when the local arterial lesions are severe. As a result of superficial venous congestion, its color is not easily affected by external temperature changes.

(3) livedo reticularis:

1 congenital reticular leukoplakia: is a rare developmental defect in the skin, the condition is more serious, often asymmetry, may be associated with skin atrophy. Generally not associated with other diseases. There is currently no effective treatment, but most patients can be relieved with age.

2 primary reticular bluish: the skin has a blue-violet reticular change, symmetrically distributed at the proximal ends of the lower limbs, sometimes in the upper limbs and torso. It often appears in winter or when it is cold, and disappears in summer or when it is warm. Generally no symptoms, or tingling, numbness or abnormal feeling when subjected to cold. The cause of this is unknown, and the cold is only a factor that induces or aggravates. Other factors that may be related to the onset are:

A. Local vascular endothelial cell damage, resulting in increased blood coagulability or decreased fibrinolytic activity.

B. Direct immunofluorescence revealed immunoglobulin or complement deposition in the vascular wall of the dermis.

Since the temperature of the bleu site is lower than normal under normal conditions, in addition to the aforementioned factors, there may be some inherent factors. If the attack continues, the skin color does not change with temperature. Or for the deposition of immune complexes, the development of functional vascular changes into organic vascular disease, that is, reticular leukocytitis, ecchymosis, hemorrhagic papules, blood blister and subcutaneous nodules and other damage. The lesion develops further into an ulcer. The diameter is 1 to 5 mm, the shape is irregular, the depth is different, there is a telangiectasia and a hemoglobin-sinking closeness, and the artery can be occluded to cause pain. The ulcer heals slowly and leaves a white atrophic scar after healing. The length of the disease varies, and the damage is repeated, so that both old and new damages exist at the same time. It is generally only skin damage, but a small number of patients develop progressively, in addition to Raynaud phenomenon and acromegaly. It can also be associated with systemic vascular disease.

Ulcers are sometimes associated with the season and are characterized by the following:

A. Winter ulcers: On the basis of existing vascular lesions, the condition may be aggravated by cold and ulceration may occur. The condition can be alleviated during the warm season. Sometimes accompanied by vascular lesions in other areas.

B. Summer ulcers: In the summer, the patient's lower extremity edema, and then a blue-purple nodule occurs in the ankle and the back of the foot, further developing into an ulcer. This may be due to vascular disease, resulting in long-term congestion and edema. In the winter, there is a tendency to heal. Generally not associated with systemic vascular disease.

3 secondary reticular leukoplakia: caused by various reasons, often associated with some systemic diseases, and bluish lesions often appear before systemic diseases. The manifestations of skin damage are similar to those of the primary one. The distribution of damage is related to the associated disease, often dendritic, asymmetric, reflecting local damage.

2. Organic vascular changes

There are different opinions on the similarities and differences between these diseases such as reticular crotic vasculitis, reticular leukoplakia vasculitis, segmental transparent vasculitis and white atrophy. Among the cases of cutaneous vasculitis damage and reticular plaque damage in these diseases, only about half of the cases have reticular leukoplakia on both sides of the thigh, and both appear 1 to 3 years after calf vascular disease, occur in winter and disappear in summer. No cases of organic vasculitis damage have been developed on this basis; and vasculitis skin lesions occur in the calf, the primary lesion is a large needle point, and then develops into a pigmented atrophic scar, which may be surrounded by Capillary dilatation and new imperfections, and more often in summer, reduced in winter, treated with the same drug, calf vasculitis damage, and ineffective for reticular plaque damage in the thigh. Similar diseases in the Japanese literature, with or without reticular bluish, are often referred to as reticular leukoplakia. White atrophy, in addition to reticular leukocytitis, can also be seen after the healing of varicose veins, and may be the result of other small causes of occlusion of small blood vessels. Therefore, it is the result of occlusion of small blood vessels in the skin due to different reasons, and it is a symptom rather than an independent disease. It is believed in the literature that segmental transparent vasculitis and reticular leukocytitis are two distinct independent diseases with their own characteristics. Reticulated bleu is mainly a functional vascular disorder and is a concomitant lesion of various diseases.

Examination of reticular bleu and leukoplakia

Perform laboratory tests according to different complications.

Diagnosis and differentiation of reticular leukoplakia and leukoplakia vasculitis

According to the clinical manifestations can be diagnosed, histopathological examination has the value of auxiliary diagnosis.

It needs to be differentiated from systemic vasculitis and connective tissue diseases.

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