Dissemond Joachim
Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
Z Gerontol Geriatr. 2023 Jul;56(4):317-323. doi: 10.1007/s00391-023-02166-3. Epub 2023 Mar 9.
Wounds of the skin can have very different causes. Especially in clinically atypical or non-healing wounds, the very heterogeneous group of vasculitides is of particularly important differential diagnostic significance. Nowadays, the classification of vasculitis is based on the affected vessels according to the Chapel Hill consensus conference. Thus, potentially any part of the vascular system can be affected. It becomes clear that there is often a risk of systemic diseases with high interdisciplinary relevance.Clinically, the usually very painful wounds in cutaneous vasculitis develop from necrosis and are typically surrounded by an erythematous-livid rim in the florid phase. In addition to clinical inspection, the histopathological examination of biopsies is of particular importance in the usually extensive diagnostic work-up.Therapeutically, adequate wound treatment should always be performed with a focus on pain prevention and infection prophylaxis. In the case of edema, compression therapy also supports wound healing. In addition, it is often necessary to initiate systemic treatment with immunosuppressive or immunomodulating drugs. Whenever possible, causally relevant factors and comorbidities should be diagnosed early and avoided or treated. Otherwise, there is a risk of severe or even fatal disease progression.
皮肤伤口可能有非常不同的成因。特别是在临床非典型或不愈合伤口中,种类繁多的血管炎在鉴别诊断中具有特别重要的意义。如今,根据 Chapel Hill 共识会议,血管炎的分类是基于受累血管。因此,血管系统的任何部分都可能受到影响。很明显,经常存在具有高度跨学科相关性的全身性疾病风险。临床上,皮肤血管炎中通常非常疼痛的伤口由坏死发展而来,在急性期通常被红斑性青紫色边缘包围。除了临床检查外,活检的组织病理学检查在通常广泛的诊断工作中尤为重要。在治疗方面,应始终进行充分的伤口治疗,重点是预防疼痛和预防感染。对于水肿,压迫疗法也有助于伤口愈合。此外,通常有必要开始使用免疫抑制或免疫调节药物进行全身治疗。只要有可能,应尽早诊断出因果相关因素和合并症并避免或治疗。否则,存在疾病严重甚至致命进展的风险。