Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Blotzheim, Leonardo Glutz von; Tanner, Felix C.; Noll, Georg; Brock, Matthias; Fischler, Manuel; Hafner, Jürg; Speich, Rudolf; Ulrich, Silvia; Huber, Lars C

doi:10.1186/1465-9921-13-45

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…A comparison with other patient populations shows high vascular comorbidity, including an increased risk of pulmonaly hypertension. 79,85 This is a logical consequence of pathophysiology, since arterial hypertension affects all organs.…”

Section: Pathophysiologymentioning

confidence: 99%

“…At the same time, the vascular compensation mechanisms are also impaired 84 , and capillary density is reduced. A comparison with other patient populations shows high vascular comorbidity, including an increased risk of pulmonaly hypertension 79,85 . This is a logical consequence of pathophysiology, since arterial hypertension affects all organs.…”

Section: Hypertensive Leg Ulcer (Martorell's Ulcer)mentioning

confidence: 99%

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Occlusive cutaneous vasculopathies as cause of chronic ulcers

Ronicke,

Berking,

Erfurt‐Berge

2024

J Deutsche Derma Gesell

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SummaryThe term occluding vasculopathies covers a large number of different conditions. These often manifest as skin ulcers. Occluding vasculopathies should be considered in the differential diagnosis of leg ulcers. The term “occlusive vasculopathies” encompasses pathophysiologically related entities that share structural or thrombotic obliteration of small cutaneous vessels. In this article, we will focus on livedoid vasculopathy with and without antiphospholipid syndrome and calciphylaxis with differentiation from hypertonic leg ulcer as the most relevant differential diagnoses of leg ulcer. The term also includes vascular occlusion, for example due to oxalate or cholesterol embolism, and septic vasculopathy. This often leads to acral ulceration and is therefore not a differential diagnosis with classic leg ulcers. It will not be discussed in this article.Occlusive vasculopathy may be suspected in the presence of the typical livedo racemosa or (non‐inflammatory) retiform purpura as a sign of reduced cutaneous perfusion in the wound area. Inflammatory dermatoses, especially vasculitides, must be differentiated. This is achieved by histopathological evaluation of a tissue sample of sufficient size and depth taken at the appropriate time. In addition, specific laboratory parameters, particularly coagulation parameters, can support the diagnosis.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Hypertensive Leg Ulcer (Martorell's Ulcer)mentioning

confidence: 99%

Occlusive cutaneous vasculopathies as cause of chronic ulcers

Ronicke,

Berking,

Erfurt‐Berge

2024

J Deutsche Derma Gesell

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“…Gleichzeitig sind dadurch auch die vaskulären Kompensationsmechanismen beeinträchtigt 84 und die Kapillardichte ist reduziert. Der Vergleich mit anderen Patientengruppen zeigt eine hohe vaskuläre Komorbidität, einschließlich einem erhöhten Risiko für pulmonale Hypertension 79,85 . Dies ist letztlich eine logische Folge der Pathophysiologie, da alle Organe der arteriellen Hypertonie ausgesetzt sind.…”

Section: Ulcus Cruris Hypertonicum (Martorell)unclassified

Okkludierende kutane Vaskulopathien als Ursachen chronischer Unterschenkelulzerationen

Ronicke,

Berking,

Erfurt‐Berge

2024

J Deutsche Derma Gesell

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ZusammenfassungUnter den Begriff der okkludierenden Vaskulopathien fällt eine Reihe unterschiedlicher Krankheitsbilder. Diese manifestieren sich an der Haut häufig mit Ulzerationen. Gerade bei Ulzerationen der Unterschenkel sollten okkludierende Vaskulopathien in die differenzialdiagnostischen Überlegungen einbezogen werden. Der Begriff „okkludierende Vaskulopathien“ umfasst pathophysiologisch verwandte Entitäten, die eine strukturelle oder thrombotische Obliteration von kleinsten Hautgefäßen gemein haben. In diesem Artikel wird vor allem auf die Livedovaskulopathie mit und ohne Antiphospholipidsyndrom sowie die Calciphylaxie mit Abgrenzung zum Ulcus cruris hypertonicum als die relevantesten Differenzialdiagnosen von Unterschenkelulzerationen eingegangen. Der Begriff umfasst auch Gefäßverschlüsse, beispielsweise durch Oxalat oder Cholesterinembolie, sowie die septische Vaskulopathie. Diese führt häufig zu akralen Ulzerationen und stellt somit keine Differenzialdiagnose zum klassischen Ulcus cruris dar. Sie wird daher in diesem Artikel nicht behandelt.Der Verdacht einer okkludierenden Vaskulopathie kann über die typische Livedo racemosa beziehungsweise die (nichtinflammatorische) retiforme Purpura als Zeichen der kutanen Minderdurchblutung in der Wundumgebung gestellt werden. Entzündliche Dermatosen, insbesondere Vaskulitiden, müssen differenzialdiagnostisch abgegrenzt werden. Dies geschieht zum Teil klinisch und durch die histopathologische Beurteilung einer Gewebeprobe, die in ausreichender Größe und Tiefe sowie zum richtigen Zeitpunkt entnommen werden muss. Ergänzend können spezifische Laborparameter, insbesondere die Gerinnungsdiagnostik, die Diagnosestellung unterstützen.

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“…The ischaemic wound border is discerned by a violaceous hue and an undermined appearance. Individuals afflicted by Martorell HYTILU endure intense pain, disrupted sleep, and a pervasive sense of exhaustion (1)(2)(3). Histological examination reveals subcutaneous arterioles exhibiting thickened walls, often at the expense of a narrow lumen.…”

mentioning

confidence: 99%

Identifying Key Drivers in the Pathogenesis of Martorell Hypertensive Ischaemic Leg Ulcer: A Comparative Analysis with Chronic Venous Leg Ulcer

Hess,

Barysch-Bonderer,

Seeli

et al. 2024

Acta Derm Venereol

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Martorell hypertensive ischaemic leg ulcer (Martorell HYTILU) is a rare but significant cause of distal leg ulcers. Although hypertension and diabetes are known factors in its development, the precise pathogenesis of Martorell HYTILU remains elusive. To reach a better understanding of Martorell HYTILU, transcriptomic analysis was conducted through RNA sequencing and immunohistochemical comparison of Martorell HYTILU (n = 17) with chronic venous ulcers (n = 4) and healthy skin (n = 4). Gene expression analysis showed a marked activation of immune-related pathways in both Martorell HYTILU and chronic venous ulcers compared with healthy skin. Notably, neutrophil activity was substantially higher in Martorell HYTILU. While pathway analysis revealed a mild downregulation of several immune pathways in Martorell HYTILU compared with chronic venous ulcers, keratinization, cornification, and epidermis development were significantly upregulated in Martorell HYTILU. Additionally, STAC2, a gene encoding for a protein promoting the expression of the calcium channel Cav1.1, was significantly upregulated in Martorell HYTILU and was detected perivascularly in situ (Martorell HYTILU n = 24; chronic venous ulcers n = 9, healthy skin n = 11). The high expression of STAC2 in Martorell HYTILU suggests that increased calcium influx plays an important role in the pathogenesis of the disease. Consequently, calcium channel antagonists could be a promising treatment avenue for Martorell HYTILU.

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Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Cited by 4 publications

References 17 publications

Occlusive cutaneous vasculopathies as cause of chronic ulcers

Occlusive cutaneous vasculopathies as cause of chronic ulcers

Okkludierende kutane Vaskulopathien als Ursachen chronischer Unterschenkelulzerationen

Identifying Key Drivers in the Pathogenesis of Martorell Hypertensive Ischaemic Leg Ulcer: A Comparative Analysis with Chronic Venous Leg Ulcer

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