Cutaneous Vasculitis and Vasculopathy

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Background

Vasculitis refers to a broad spectrum of diseases characterized by inflammation and the destruction of blood vessels and can develop in any organ of the body. The skin is one of the most commonly affected organs, and small-vessel vasculitis of the skin is the most frequent type of vasculitis. Cutaneous Vasculitis (CV) may be a component of systemic vasculitis, including the skin, skin-limited or skin-dominant expression, or variant of systemic vasculitis. Finally, it may be a single-organ vasculitis of the skin. Identifying the etiologic factors causing CV can be a diagnostic challenge, and a wide range of diseases can be considered in its differential diagnosis. Therefore it is important to highlight the morphological components and clinicopathologic correlation of elementary lesions, which may increase the speed and accuracy of diagnosis. Here, morphological features of purpuric lesions, including size, erythema, palpability, symmetry or retiform pattern (branched/star-shaped purpuric lesions), may provide clues to possible etiologies. Although palpable purpura is the most critical lesion, many different elementary lesions can be obtained in the vasculitis spectrum. The depth of the vessels affected determines the type of cutaneous lesions. Small superficial vessel involvement often results in urticarial papules, plaques and palpable purpura. Deeper involvement (dermohypodermic junction/hypodermis) causes ulcers, nodules, or livedo. The cells in the inflammatory infiltrate, and the type of inflammation is also critical in diagnosing CV.

Dermatologists are privileged in diagnosing vasculitis because of the high prevalence of cutaneous involvement and the easy accessibility of the skin for detailed examination and sampling. Although skin manifestations are multiple and polymorphic, they can provide valuable information about the diameter of the affected vessel and the type of vasculitis
In this Research Topic, we aim to inspect the recent developments in CV by reviewing the current state of knowledge regarding the epidemiology, etiopathogenesis, clinical features, diagnosis, differential diagnosis and therapeutic treatments. We will also review vasculitis with emphasis on the dermatological aspects. Since there is no agreement yet on the nomenclature for CV, we will start by reviewing the latest developments in the nomenclature. We will also review the cutaneous manifestations and pathophysiological mechanisms of vasculitis involving different vessel diameters in different topics. Vasculitic changes seen in the era of Covid-19 pandemic may be diagnostic and/or prognostic, which will be discussed.

Vasculitis diagnosis is based on history, clinical, histopathological, and other laboratory findings. We will propose an algorithmic approach developed by combining the latest literature and our experience in this field to aid in the diagnosis. Benefiting from a wealth of new knowledge generation, expertise, and experience worldwide, we will concentrate on future directions in CV. Finally, we will try to summarize the most recent developments in treatment. We will try to explain all aspects of the CV to the readers with a holistic approach with the help of very well-known authors in their fields.

Keywords: Cutaneous Vasculitis, Vasculopathy, Vasculitis

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