Livedo reticularis and gangrene

Introduction "Reticulated bluish" is a skin rickets that is a skin manifestation of certain diseases. Some normal people also have reticular bluish spots in cold environments. Gangrene is a special morphological change such as black and dark green, which is caused by infection and other factors of secondary spoilage after tissue necrosis. Both appear at the same time, which can be seen in the skin damage of nodular polyarteritis. Nodular polyarteritis, also known as nodular arteritis, necrotic arteritis, polyarteritis, etc., is a fatal disease. The clinical pathological process develops rapidly, and the lesions are extensive, usually involving the systemic arterial system. The clinical manifestations are complex and variable, and vary according to the location or organ involved in the lesion.

Cause

Causes of reticular bluish and gangrene:

Nodular polyarteritis is classified into a variety of Chinese medical conditions because of its diverse clinical manifestations. Chinese medicine believes that it is closely related to fiery heat, phlegm and blood stasis, and ultimately leads to choroidal obstruction, qi stagnation, blood stasis and obstruction and cost.

an examination

Related inspection

Blood routine brain Doppler ultrasound (TCD)

Diagnosis of reticular bluish and gangrene:

The most common early manifestations were unexplained fever, hypertension, acute abdominal pain, glomerulonephritis, coronary insufficiency, peripheral neuropathy, and muscle and joint lesions. There may be no local symptoms, or only the localized lesions of the skin. According to the lesions involving the tissues and organs, the nodular polyarteritis is divided into two types: systemic (systemic) and localized.

Differential diagnosis

Differential diagnosis of reticular bluish and gangrene:

Reticulated bluish: It is a skin-limited purple-blue reticular bluish that occurs due to local vasomotor dysfunction of the skin, resulting in the expansion of small arteriolar spasm and small veins, and stagnant blood. It is divided into primary and secondary. Primary reticular leukoplakia occurs in normal children and young women. Reticulated bleu is often found in the exposed parts of the limbs, such as the hands, forearms, ankles and calves. Along with the entire limb, a small number of patients can also occur in the face and torso. The patient is afraid of cold, cold feelings, swelling and paresthesia during the attack, frequent episodes in the cold season, rare episodes in the warm season, and obvious spots when the limbs sag, and the markings are alleviated or disappeared when lifted or touched by hand. Not accompanied by systemic symptoms.

Bad sputum: It is a destructive necrotizing, non-infectious skin ulcer. It also has sputum-like nodules, pustules or hemorrhagic bullae. In the case of early nodular erythema or pustules, it can be attributed to vasculitis. The tender erythema of the nodule is red at first, and then becomes blue in the center, eventually forming an ulcer. One or more vesicular pustules, similar to acne, folliculitis, transient acantholytic dermatosis or herpes-like dermatitis. Both lesions can appear at the same time, and they can also change each other. Skin lesions can occur in normal skin or areas of the original skin disease. Painful ulcers on the stalk edge and oozing yellowish green pus with malodor have diagnostic value. Oral high-dose corticosteroids are given once a diagnosis is made.

Dry gangrene: Mostly seen at the extremities of the extremities, such as atherosclerosis, thromboangiitis obliterans and frostbite. At this time, the artery is blocked and the venous return is smooth, so the necrotic tissue has less water, and the surface water is easy to evaporate, causing the lesion to dry and shrink, showing a dark brown color, and there is a clear boundary line with the surrounding healthy tissue. Since necrotic tissue is relatively dry, spoilage infections are generally mild.

Wet gangrene: occurs mostly in the internal organs (intestines, uterus, lungs, etc.) that are connected to the outside world, and can also be seen in limbs (with congestion and edema). Due to the high water content of the necrotic tissue, the spoilage bacteria are seriously infected, and the local area is obviously swollen, and it is dark green or dirty black. The spoilage bacteria break down proteins, produce sputum, skatole, etc., causing bad odor.

The most common early manifestations were unexplained fever, hypertension, acute abdominal pain, glomerulonephritis, coronary insufficiency, peripheral neuropathy, and muscle and joint lesions. There may be no local symptoms, or only the localized lesions of the skin. According to the lesions involving the tissues and organs, the nodular polyarteritis is divided into two types: systemic (systemic) and localized.

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