Allergic vaskulit — the aseptic inflammation of a vascular wall caused by allergic reaction to influence of various infectious and toxic factors. The expressed polymorphism of rashes and options of a current of an allergic vaskulit led to the fact that its many forms are allocated as separate diseases among which there is a global division into superficial and deep allergic vaskulita. Diagnostics of an allergic vaskulit demands an integrated approach taking into account the anamnesis, features of a clinical picture, laboratory and tool yielded, results of histology. Treatment of an allergic vaskulit is carried out by the antihistaminic, desensibilizing and vascular means, calcium medicines, antibiotics, glucocorticoids and so forth.
Unlike system vaskulit, allergic vaskulit proceeds with primary defeat of the vessels located in skin and hypodermic cellulose, often without involvement in process of vessels of internals. There are no exact data on incidence of an allergic vaskulit. It can develop at people of any gender and at any age. Dependence of frequency of cases of an allergic vaskulit on age or a sex of patients is observed at separate clinical forms of a disease. For example, a hemorrhagic vaskulit children up to 14 years are ill more often, and Shamberg's dermatosis occurs generally at men.
Reasons and mechanism of emergence of an allergic vaskulit
Allergic vaskulit belongs to diseases with a multifactorial etiology. Most often the organism sensitization various infectious agents (stafilokokka, streptococci, pathogenic mushrooms, viruses) developing against the background of the chronic infectious centers leads to its development (tonsillitis, otitis, antritis, an adneksit, chronic pyelonephritis, cystitis, tuberculosis and so forth), frequent SARS, flu, herpetic infections, viral hepatitis B, C, A. U of many patients decide on an allergic vaskulit high credits anti- staphylococcus and antistreptolizina-0, increase in anti-staphylococcal gemagglyutinin.
Medicamentous medicines (sulfanylamides, antibiotics, oral contraceptives, analgetics, barbiturates, etc.) and chemicals (oil products, insecticides) concern to the following group of the factors provoking development of an allergic vaskulit. Household and vegetable allergens, long intoxications, radiation can become the reason of an allergic vaskulit. As a favorable background for development of an allergic vaskulit the exchange deviations (diabetes, gout, obesity, atherosclerosis) occurring in an organism, vascular disorders (a hypertension, varicosity, heart failure) and diseases of somatic bodies, first of all a liver can serve: biliarny cirrhosis, chronic hepatitis, alcoholic liver disease.
Complex influence of infectious and toxic factors causes formation of the CEC and their adjournment in a vascular wall that leads to its damage with development of an aseptic inflammation and the increased permeability of a vessel. So there is allergic vaskulit. Many researchers of this problem I point to interrelation of weight of an allergic vaskulit with quantity of the immune complexes circulating in blood.
Classification of an allergic vaskulit
Clinical classification of an allergic vaskulit which is used by modern rheumatology is based on caliber of the struck vessels. It agrees with it allocate:
Superficial allergic vaskulit — is characterized by defeat of capillaries, small faded also skin arteries. Gemosideroza concern to this group, hemorrhagic vaskulit, nodular necrotic vaskulit, allergic arteriolit Ruter, ospennovidny sharp likhenoidny parapsoriasis and hemorrhagic leykoklasticheskiya .
Deep allergic vaskulit — is followed by damage of the arteries and veins of average and large caliber passing in hypodermic fatty cellulose and on its border from dermy. It is clinically shown by various forms of a sharp and chronic knotty eritema.
The clinical kinds of an allergic vaskulit caused by defeat an endoteliya of prekapillyar and capillaries with adjournment of a gemosiderin — the ferriferous pigment forming after hemoglobin disintegration enter into group of gemosideroz. These options of an allergic vaskulit are characterized by emergence on skin of petekhialny rashes, small yellowy-brown spots and vascular asterisks. Rash in most cases settles down in disteel departments of extremities, a thicket — standing. Rashes can be followed by an itch of various intensity. The general condition of patients, as a rule, is not broken. Formation of a trophic ulcer is in certain cases possible.
Carry the following options of an allergic vaskulit to gemosideroza: Mayokki's disease (ring-shaped teleangiektatichesky to purple), ekzematoidny to purple (Dukasa-Kapetana-kisa), purpurozny pigmentary angiodermit Shamberg's disease itching to purple (Levental), purpurozny pigmentary likhenoidny dermatitis (Guzhero-Blum's syndrome), the arc-shaped teleangiektatichesky to purple (Touraine), a white atrophy of skin (Milian) (Favra-Sheh's syndrome), orthostatic to purple and mesh senile .
Hemorrhagic vaskulit (Shenleyna-Genokh's disease)
This type of an allergic vaskulit is shown by defeat an endoteliya not only skin vessels, but also internals. At the same time the aseptic inflammation of a vascular wall is followed by formation of microblood clots. Allocate the following forms of a hemorrhagic allergic vaskulit: skin and articulate with rashes in the form of hemorrhagic and eritematozny spots and damage of large joints as arthritis; abdominal with sharp belly-ache and intestinal bleedings; kidney, proceeding with symptoms of a sharp or chronic glomerulonefrit; lightning necrotic, often terminating in a lethal outcome because of multiple damage of internals with development of myocarditis, pleurisy, polyarthritis, gastrointestinal and nasal bleedings, a glomerulonefrita; mixed.
The differential diagnosis of the allergic vaskulit proceeding as Shenleyna-Genokh's disease is carried out with mnogoformny ekssudativny eritemy, medicamentous dermatitis, a nodular periarteriit, a hemorrhagic syndrome of infectious diseases.
Nodular necrotic vaskulit
This kind of an allergic vaskulit differs in a chronic current with deterioration in the general state. Skin manifestations are characterized by nodular elements and eritematozny spots with a hemorrhagic component. Demands a differentiation from a papulonekrotichesky form of tuberculosis of skin.
Allergic arteriolit Ruter
Allergic vaskulit Ruter is characterized by polymorphism of the rashes which are followed by violation of the general health of the patient (headaches, an indisposition, subfebrilitt, artralgiya, sometimes inflammatory changes of joints). Rashes can be presented by papules, spots, pustula, vascular asterisks, blisters, vesicles, sites of a necrosis and an ulceration. On the prevailing rash elements this type of an allergic vaskulit is divided on nodular and necrotic, hemorrhagic and polymorphic and nodular.
The knotty eritema can have sharp and chronic option of a current. At this type of an allergic vaskulit there is a formation of the dense painful hypodermic small knots and knots which are localized mainly on the forward surface of shins. Permission of knots occurs without destruction. On their place a long time consolidations can remain. The disease proceeds with violation of the general state, emergence of symmetric artralgiya and arthritises.
Diagnostics of an allergic vaskulit
Patients with suspicion on allergic vaskulit need consultation of the rheumatologist. Because of the expressed variety of manifestations and forms of an allergic vaskulit its diagnostics is a complex challenge for the doctor. The given the anamnesis, clinical pictures of a disease, character of a current, age of the patient, results of laboratory researches and the histologic studying taken by a material skin biopsy are considered.
From laboratory methods of diagnostics at an allergic vaskulit are applied clinical blood test and urine, blood test on sugar, biochemical tests of a liver, definition of ASL-O and CEC. The histologic picture of an allergic vaskulit is characterized by swelling and puffiness an endoteliya of skin and hypodermic vessels, its growth with narrowing of a gleam of the struck vessel, leykotsitarny infiltration of a vascular wall, adjournment in it of a gemorsiderin, microthromboses and an exit of elements of blood out of vessel limits. Carrying out the REEF allows to reveal adjournment in a wall of the struck vessel of immunoglobulins and complexes an anti-gene antibody.
For identification of the chronic infectious centers in an organism during diagnostics of an allergic vaskulit the calla and dab from a nasopharynx, gynecologic inspection of women, PTsR-researches on various infections, the RPR test, inspection at the phthisiatrician is carried out urine. Diagnosis of the accompanying vascular disorders can demand consultation of the cardiologist, the phlebologist or the vascular surgeon, carrying out the ECG, an angiography, UZDG of arteries and veins.
Treatment of an allergic vaskulit
Therapy of an allergic vaskulit is carried out desensibilizing and antihistamines, calcium medicines. The vascular medicines directed to improvement of a vascular tone, decrease in permeability of a vessel and a tromboobrazovaniye in its gleam are widely applied. Treat them: hydroxyethylrutoside, etamsylate, ascorbic acid + rutoside, , aminocaproic acid, horse-chestnut extract and so forth. In hard cases of an allergic vaskulit application of glucocorticosteroids and tsitostatik, extracorporal haemo correction is shown (haemo sorption, a membrane plasma exchange, etc.). In the presence of the infectious centers their sanitation and system antibacterial therapy is necessary.
In treatment of an allergic vaskulit can be applied and external means, generally it is the creams and ointments containing , a klostridiopeptidaza, chloramphenicol, extract of blood of cattle, etc. If allergic vaskulit is followed by an articulate syndrome, locally appoint anti-inflammatory ointments, bandages with a dimethyl sulfoxide, and magnetotherapy.