Die leukozytoklastische Vaskulitis

Zusammenfassung

Die leukozytoklastische Vaskulitis stellt als häufigste Vaskulitis der Haut eine differenzialdiagnostische Herausforderung für Dermatologen und Rheumatologen dar. Als Immunkomplexvaskulitis entsteht die leukozytoklastische Vaskulitis durch Ablagerung von Immunkomplexen an der Gefäßwand. In der Hautbiopsie mit direkter Immunfluoreszenz kann eine IgA- von einer IgM- beziehungsweise IgG-Ablagerung unterschieden werden. Die Purpura Schönlein-Henoch ist die häufigste Vaskulitis des Kindesalters und besitzt eine sehr gute Prognose. Bei Vorhandensein von IgM/IgG-Immunkomplexen sollten differenzialdiagnostisch Infektionen, maligne Grunderkrankungen, Medikamentennebenwirkungen und entzündlich-rheumatische Erkrankungen ausgeschlossen werden. Unkomplizierte Verlaufsformen der leukozytoklastischen Vaskulitis können symptomatisch behandelt werden. Kortikosteroide sind bei ausgedehnten Nekrosen und Ulzerationen der Haut indiziert. Systemische Beteiligungen müssen frühzeitig detektiert und gegebenenfalls immunsuppressiv behandelt werden. Ingesamt besitzt die leukozytoklastische Vaskulitis jedoch eine sehr gute Prognose und zeigt meist einen selbstlimitierenden Verlauf.

Summary

Leukocytoclastic vasculitis is the most common cutaneous vasculitis and represents a challenge in differential diagnosis for dermatologists and rheumatologists. Disease manifestation results from deposition of immune complexes in the vascular wall. IgA-complexes can be distinguished from IgM/IgG-complexes by means of direct immunofluorescence from cutaneous biopsy. Henoch-Schönlein purpura is the most common vasculitis in children with an excellent prognosis. If IgM/IgG-complexes are detected underlying infections, neoplastic diseases, drug reactions and rheumatic diseases should be considered. Uncomplicated cases of leukocytoclastic vasculitis can be treated symptomatically. Steroids are indicated if cutaneous necrosis or ulcerations occur. Systemic involvement has to be detected early and should be treated with immunosuppressants. However, in most cases leukocytoclastic vasculitis is self-limiting with an excellent prognosis.

Schlüsselwörter

Leukozytoklastische Vaskulitis - kutane Vaskulitis - Vaskulitis - Purpura Schönlein-Henoch

Keywords

Leukocytoclastic vasculitis - cutaneous vasculitis - vasculitis - Henoch-Schönlein purpura

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