Cutaneous Vasculitis: What Are These Red and Purple Rashes?

Cutaneous vasculitis is a type of vasculitis that affects small- or medium-sized blood vessels in the skin. It also affects the tissue under the skin, except for the internal organs.

Cutaneous vasculitis occurs only on the skin, but it may also be a primary or secondary component of another vasculitic disorder. Purple-colored patches (purpura), red spots (petechiae), or ulcers are just some of the symptoms. If you suspect you have cutaneous vasculitis, a skin biopsy may be required to get a proper diagnosis. And if the diagnosis shows you do have the condition, the kind of treatment that will help in the management of cutaneous vasculitis depends on the cause and extent of the disease.

What Is Vasculitis? How Is Cutaneous Vasculitis Different?

In general, vasculitis occurs when the blood vessels are inflamed. During an inflammation, the walls of the blood vessels thicken. The passageway through the vessel becomes narrow and blood flow becomes restricted. Vasculitis can also result in organ and tissue damage.

Cutaneous vasculitis is just one of many disorders that involves inflammation and blood vessels. This group of disorders is known as the vasculitides or the vasculitic syndromes. These syndromes range from slightly serious disorders of the skin to more serious ones which affect other organs.

Symptoms of Cutaneous Vasculitis

Management of cutaneous vasculitis symptoms can be confusing because it has several manifestations. These include urticaria (hives), hemorrhagic lesions, ulcers, nodules, rashes with a reddish netlike pattern, or in severe cases, gangrene.

When pressed, the red or purple spots which commonly appear on the skin do not change color. They may appear like bruises or lumps on the skin. Each spot or lump is typically small, about 1 millimeter to several centimeters. They can be painful, and can also give a burning and itching sensation.

Cutaneous vasculitis most commonly affects the ankles and lower legs, as well as the feet. 

It is usually a component of other illnesses such as lupus or rheumatoid vasculitis and Churg-Strauss syndrome. 

Other general signs and symptoms include:

Causes of Cutaneous Vasculitis

The exact cause of this disease is unknown. A study shows that 15-20% of CNV cases manifested after an infection, 15-20% are due to connective tissue diseases, 10-15% are due to reactions to drugs, and 5% are responses to cancer cells. CNV can trigger the body’s immune system to work harder, and the increased production of inflammatory mediators can cause damage to blood vessel walls. Fluid may also leak from the damaged blood vessels into neighboring tissues. This can result in swelling of the lower legs.

While the exact causes of CNV are still unknown, some conditions may be linked:

1. Infections

When a person has a viral or bacterial illness, symptoms of CNV can occur within 7-10 days. It may also occur due to fungal infections or parasites. Other known causes of CNV include infections such as hepatitis B and hepatitis C. 

2. Autoimmune Conditions

CNV may occur in patients with autoimmune diseases (where the immune system reacts against patients own tissues) such as rheumatoid arthritis, lupus and inflammatory bowel disease.

3. Cancer or Blood Disorders

Increased thickening of the blood may also be associated with cancers, specifically blood cancers. Excessive development of antibodies can  cause damage to the blood vessels. Abnormalities of the red or white blood cells may also cause CNV. 

4. Medications

There are several drugs that are associated with drug-induced vasculitis. Antibiotics, anticonvulsants, water pills (diuretics) and nonsteroidal antiinflammatory medications are the usual initial suspects of causing CNV rashes.

Treatment of Cutaneous Vasculitis

Management of cutaneous vasculitis symptoms can be as simple as removing the possible triggers. However, more severe cases may need extensive therapies.

In most instances, cutaneous vasculitis can occur for a limited time only. In these instances, treatment can include: 

More extensive therapy is indicated for symptomatic, recurrent, extensive, and persistent skin disease. But for mild recurrent or persistent disease, colchicine and dapsone are first-choice agents. 

In more severe cases, particularly those that are accompanied by ulcers, intake of oral medication may be needed. These medications can be Colchicine, Dapsone, or oral corticosteroids. Immunotherapy may also be required to adjust the immune system. 

Learn more about Other Cardiovascular Issues here.