血管炎における皮膚病変

Skin Manifestations of Vasculitis

血管炎で生じる皮膚症状には紫斑，水疱，潰瘍，リベド，皮下硬結などがある。特にpalpable purpura（触知性紫斑）とリベドおよび皮下硬結は重要であり，前者は小型血管炎で見られ，後者は中型血管炎で見られることを認識する。活動性のある皮膚症状から，深い病変では脂肪組織のレベルまで生検を行うことで正確な診断に至る。障害される血管のサイズにより鑑別診断を行う。血管炎の診療には各内科，皮膚科，病理科などの密な連携が必要である。

Abstract

Skin symptoms that might indicate vasculitis include palpable purpura, blisters, skin ulcers, livedo, and subcutaneous nodules. Palpable purpura, livedo, and subcutaneous nodules are particularly important; the first correlates with small vessel vasculitis, and the latter two with medium vessel vasculitis on histopathology. If the presence of deep lesions, as seen in cases of livedo and subcutaneous nodules are suspected, the skin biopsy must include fat tissue from the active skin lesions to arrive at the accurate histological diagnosis. Differential diagnoses should be considered based on the size of the most heavily impacted vessels, to determine the type of vasculitis. The diagnosis and treatment of vasculitis requires cooperation between the Nephrology, Neurology, Respiratory Medicine, Rheumatology, Dermatology, and Pathology Departments.