Differentialdiagnose der Livedosyndrome

Zelger, Bernhard; Plörer, A; Sepp, Norbert; Fritsch, Peter

doi:10.1007/s001050050268

Cited by 17 publications

(7 citation statements)

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“…However, pathogenetic evaluation is crucial. Laboratory tests (Table 1a) [21,22], and imaging (especially in medium vessel vasculopathies; Table 1b), are necessary and used to verify or falsify diagnoses, based primarily on clinical and histopathological data. In addition, other specialties, in particular cardiology, pneumology, nephrology, rheumatology, neurology and ophthalmology, must frequently be included in a multidisciplinary approach to optimal patient management.…”

Section: Introductionmentioning

confidence: 99%

Bar code reader – an algorithmic approach to cutaneous occluding vasculopathies? Part I: small vessel vasculopathies

Ratzinger

Zelger

2019

J Deutsche Derma Gesell

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SummaryAimsThe classifications of occluding vasculopathies may present some difficulties. Firstly, classifications may follow different principles, e.g. clinicopathological findings, etiology or pathomechanism. Secondly, authors sometimes do not distinguish between vasculitis and vasculopathy. Thirdly, vasculopathies are often systemic diseases. Organ‐specific variations make morphologic findings difficult to compare. Moreover, subtle changes may be recognized in the skin, but be invisible in other organs. Our aim was to use the skin and subcutis as tools and clinicopathological correlation as the basic process for classification.Methods and resultsIn the first step, we differentiate between small and medium vessel occluding vasculopathies in the skin, and focus in this part on small vessel occluding vasculopathies. In the second step, we differentiate among subtypes of small vessels. In the final step, we differentiate according to the time point of the coagulation/reorganization process and the involved inflammatory cells/stromal features. Applying the same procedure to the various entities and visualizing the findings with bar codes makes the similarities and differences more apparent, both clinically and with histopathology.ConclusionOccluding vasculopathies are often not separate entities, but reaction patterns and epiphenomena. Distinguishing them from vasculitides is crucial because of differences in pathogenesis, therapeutic approach and prognosis.

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Section: Introductionmentioning

confidence: 99%

Bar code reader – an algorithmic approach to cutaneous occluding vasculopathies? Part I: small vessel vasculopathies

Ratzinger

Zelger

2019

J Deutsche Derma Gesell

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“…Such an irregular pattern results from irregularly distributed vascular occlusions (eg, vasculitis or Sneddon's syndrome). 2 Livedo racemosa with skin erosions on the shoulder and arm in our patient resulted from ischemic necrosis because of a large plexiform neurofibroma of the brachial plexus compromising arterial blood flow. This had caused the pulselessness of the left radial artery, focal osteolysis, and dysplastic bone features of the left arm.…”

Section: Discussionmentioning

confidence: 87%

Vasculopathy in von recklinghausen's neurofibromatosis–a diagnostic quandary

Obermoser

Zelger

Millonig

et al. 2004

Journal of the American Academy of Dermatology

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“…Die Livedo racemosa als Symptom der Livedo-Vaskulopathie geht auf partielle thrombotische Gefäßverschlüsse zurück (Fibrinthromben; [83]). Ihr liegen in vielen Fällen definierte prothrombotische Gerinnungsstörungen zugrunde.…”

Section: Livedo-vaskulopathieunclassified

“…Eine Livedo racemosa ist kein direktes Symptom einer Vaskulitis der kleinen Gefäße, und die Livedo-Vaskulopathie ist selber auch keine Vaskulitis [83]. Dies ist wichtig für die korrekte Therapie, da nach Ausschluss einer PAN die Gabe von Antikoagulanzien sinnvoll ist, nicht aber die von Glukokortikoiden.…”

Section: Livedo-vaskulopathieunclassified

Therapie von Vaskulitiden und Vaskulopathien

Sunderkötter

Groot

2008

Hautarzt

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Treatment and course of leukocytoclastic immune-complex vasculitis (LcV) depend on absence or presence of IgA in immune complexes [Henoch-Schoenlein-Purpura (PSH)]. LcV due to IgG- or IgM-containing immune complexes has a better prognosis. If triggers cannot be detected or avoided, symptomatic treatments are usually sufficient due to a usually favourable course. When hemorrhagic blisters suggest incipient skin necrosis corticosteroids are indicated. For chronic or relapsing LcV we suggest colchicine or dapsone. In adults with PSH and severe glomerulonephritis there is insufficient evidence for the efficacy of glucocorticoids; but e.g. ACE inhibitors can be helpful depending on symptoms. In cryoglobulinemic vasculitis underlying diseases (often plasmocytoma or hepatitis C) should be treated, sometimes supplemented by plasmapheresis. Dapsone or colchicine are usually started for urticarial vasculitis. ANCA-associated systemic vasculitis requires rapid and aggressive induction therapy, usually with glucocorticoids and cyclophosphamide. In classic polyarteriitis nodosa glucocorticoids improve prognosis, in polyarteriitis nodosa cutanea colchicine or dapsone are more appropriate. Giant cell arteriitis requires rapid therapy with glucocorticoids. For livedo vasculopathy antithrombotic measures are required with low molecular heparin or antagonists to vitamin K, for maintenance dipyridamol und aspirin.

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Differentialdiagnose der Livedosyndrome

Cited by 17 publications

References 0 publications

Bar code reader – an algorithmic approach to cutaneous occluding vasculopathies? Part I: small vessel vasculopathies

Bar code reader – an algorithmic approach to cutaneous occluding vasculopathies? Part I: small vessel vasculopathies

Vasculopathy in von recklinghausen's neurofibromatosis–a diagnostic quandary

Therapie von Vaskulitiden und Vaskulopathien

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