What is Allergic Arteriolitis, or Reuter’s Vasculitis?
This pathology belongs to the group of so-called vascular allergids. Most often, women are ill, especially young girls. Lesions are located on the legs, less often – on the hands. Factors contributing to the development of pathology are various colds and inflammatory diseases, blood stagnation in the legs (for example, in heart failure, varicose veins), diseases of the upper respiratory tract (tonsillitis, tooth pathologies, sinusitis, sinusitis, etc.).
Symptoms of Allergic Arteriolitis, or Reuter’s Vasculitis
Blisters, nodules, bleeding spots, skin necrosis, ulcers appear on the patient’s skin. Initially, they are arranged in a chaotic order, in the future there is a tendency to a symmetrical arrangement. The disease takes quite a long time, wave-like. Periods of improvement and even seemingly complete recovery alternate with new exacerbations of the process. After the healing of the skin elements, small scars remain in their place. If the skin is mostly dominated by spots of hemorrhage, then the same hemorrhage can be detected in the internal organs, most often in the stomach, intestines and kidneys. There are several varieties of Reuter’s allergic vasculitis. The main of them include:
- nodular hemorrhagic.
Papulonecrotic type. Basically on the skin of the patient there are elements of the type of nodules, the skin over which flakes. The center of them sinks in relation to the peripheral part, it is filled with a cork consisting of blood and rejected dead skin.
Polymorphic-nodular type. There are also nodules on the patient’s skin, which further heal, leaving superficial skin defects and deeper ulcers in place. There may be skin pustules.
Nodular-hemorrhagic type. Nodules for this type of disease are round or oval. The skin above them is practically unchanged and has a normal color, with the exception of the central part, where there is a film consisting of dried blood. Characterized by a different duration of the existence of skin rashes: while some of them rather quickly disintegrate, others exist for a very long time. Together with nodules on the skin, you can often find spots of hemorrhages of small sizes.
During the Reiter allergy, there is always a hidden period when there are no signs of the disease, but there are already pathological processes in the body. This distinguishes the disease in question from all other types of vasculitis. Patients during this period may complain of minor discomfort, weakness, and increased fatigue. Then pains in the joints of the legs, which are not significantly pronounced, begin to bother. There is swelling of the skin over the joints, especially the knee and elbow, ray-carpal. In a hemorrhagic type of the disease, in some cases intense abdominal pain and the appearance of blood impurities in the urine for no apparent reason may occur. The appearance of new lesions on the skin is very easily triggered when it is irritated with pressure from bandages, belts, bandages. The disease can last for different times – from several days to several months and even years.
Diagnosis of Allergic Arteriolitis, or Reuter’s Vasculitis
In the study of the patient’s skin under a microscope, it is possible to reveal the swelling of the walls of the affected vessels, especially their inner layer. They reveal a large accumulation of immune cells that have penetrated here from the bloodstream as a result of inflammatory reactions. At the same time, not only whole cells are visible, but also fragments of them, nuclear fragments (or so-called nuclear dust). Vascular walls are impregnated through fibrin – the main blood protein responsible for its clotting. Their permeability is also greatly increased, with the result that red blood cells – red blood cells – extend beyond the vessels.
In some places, the vascular wall dies off, which is clearly seen during microscopic examination. If such areas of necrosis and ulcers are formed, then in this case thrombi always appear, since the integrity of the vascular wall is the main factor hindering the process of thrombosis. At the same time, as a peculiar defensive reaction is a strong proliferation of the surviving inner layer of the vascular wall. It can be so pronounced that it completely blocks the lumen of the vessel itself, significantly hampering blood flow.
Sometimes nodules can form on the walls of blood vessels, while the microscopic picture changes significantly. A large number of various giant cells appear.
Treatment of Allergic Arteriolitis, or Reuter’s Vasculitis
Firstly, before starting any therapeutic measures, it is necessary to clearly define which form of the disease in this patient. Of great importance is the degree of activity and severity of the pathological process. It is necessary to clearly identify what exactly led to the development of the disease and what secondary factors played a role in this. All patients with moderate and severe course of the process must be in the hospital for the most complete observation, treatment and care.
In mild form, such measures are necessary only during regular exacerbations, although in such cases it can be limited to treatment at home with bed rest. Particular attention should be paid to the rational mode of the day and therapeutic measures in cases where the patient is engaged in work in production, where there is contact with harmful chemicals and physical factors. Bed rest is a very important event, but this does not mean that the patient should not move at all. Very useful gymnastics, carried out in bed. Currently developed a large variety of similar techniques. They help to improve blood flow and more quickly normalize the patient’s condition.
Another important event is diet during periods of exacerbation. At this time, sharp, smoked, fried foods, salt, canned food, chocolate, strong tea and coffee, oranges and other citrus, alcoholic beverages should be completely excluded from the patient’s diet.
Drug therapy for cutaneous vasculitis consists of the following key points.
- Treatment of the underlying disease, which, presumably, led to the development of angiitis. All harmful effects on the body are excluded. This direction of therapy is implemented with the participation of not only a dermatologist, but also a wide range of other specialists. They are also involved in the treatment of comorbidities that adversely affect the course and outcome of the underlying disease. These primarily include hypertension, diabetes mellitus, diseases of the venous vessels, especially of the lower extremities, and uterine tumors. This list can be expanded.
- General treatment of the vasculitis itself. For these purposes, hormones of the adrenal cortex, antiallergic drugs, anti-inflammatory drugs, vitamins, and in severe cases – cytostatics are mainly used. Sometimes such patients have to apply special blood purification techniques, for example, plasmapheresis. It should always be remembered that with the appearance of apparent recovery, the therapy of the disease does not end there. The above preparations can be canceled only in cases when there is a complete normalization of laboratory research indicators. But even in these cases, they are not canceled completely, and the patient remains on so-called supportive therapy for 6–12 months. Only in this case there is hope for a full recovery. As can be seen from the above, the treatment of skin vasculitis is quite complex, so it should be appointed only by an experienced specialist.
- Local therapy of cutaneous manifestations. Mostly used ointments, which include in its composition preparations of adrenal hormones. Daily thorough skin care of the patient with the use of antiseptics.
- Rehabilitation. Patients who have undergone these diseases or are in the stage of well-being should always be informed of the need to comply with certain preventive measures in order to prevent the exacerbation or development of the disease anew. First of all, it is necessary to completely exclude all effects on the body that are provoking effects against skin vaccinates. These include a long stay in the cold, heavy physical exertion, frequent stress, walking for a long time, injury. Almost all of these patients in the future need to change jobs, not related to the action of harmful production factors. Some patients receive disabilities and become disabled.
Very important is the commitment of the patient to a healthy lifestyle. Activities such as morning exercises, tempering procedures, walks in the fresh air, swimming, healthy normal sleep for at least 6-8 hours a day have a good effect on the body. After all the signs of the disease disappear, such patients are recommended treatment in resorts, which contributes to the persistent consolidation of the positive effect achieved during therapy. Sulfuric, carbonic, radon baths, measured physical activity (mainly in the form of walking), swimming in sea water are prescribed to all patients, especially those with heart and vascular diseases.
In milder forms, under the action of adequate therapy, the disease can be completely cured. In more severe cases, it lasts a very long time. After the healing of old lesions, new ones constantly appear in their places.