 |
|
Livedo Vasculopathy vs Small Vessel Cutaneous Vasculitis
Cytokine and Platelet P-Selectin Studies
Massimo Papi, MD;
Biagio Didona, MD;
Ornella De Pità, MD;
Alessandra Frezzolini, PhD;
Stefano Di Giulio, MD;
Walter De Matteis, MD;
Domenico Del Principe, MD;
Rino Cavalieri, MD
Arch Dermatol. 1998;134:447-452.
Objective To assess the role of platelets and lymphocyte-related immunological mechanisms in livedo vasculopathy (LV) and cutaneous small vessel vasculitis (CSVV). Livedo vasculopathy is thought to be related to the thrombotic occlusion of small and medium-sized dermal vessels. Cutaneous small vessel vasculitis comprises a heterogeneous group of disorders in which the main pathogenetic events could be modulated by circulating cytokines.
Design Case series study of 2 groups of patients affected respectively with LV and CSVV.
Setting A large clinical and research institute for the study and treatment of cutaneous diseases.
Patients Consecutive patients with clinically and histologically proved idiopathic LV (n = 8) and CSVV (n = 20) were studied and compared with healthy donors (n = 20). Patients with potentially correlated systemic diseases were excluded.
Main Outcome Measures Surface expression of platelet P-selectin and circulating level of interleukin (IL) 1 , tumor necrosis factor  (TNF-), IL-8, IL-2, and soluble IL-2 receptor.
Results The IL-2 and soluble IL-2 receptor levels were significantly higher in serum samples from patients with both LV (1.24 ± 0.46 IU/mL [mean ± SD] vs 0.46 ± 0.24 IU/mL, P<.001; 899 ± 368 IU/mL vs 628 ± 132 IU/mL, P<.02) and CSVV (0.91 ± 0.57 IU/mL, P<.02; 1087 ± 451 IU/mL, P<.001) than in those from the healthy controls. The serum levels of IL-1, TNF-, and IL-8 were higher in patients with CSVV than in controls (7.53 ± 6.7 pg/mL vs 4.58 ± 2.72 pg/mL; 23.7 ± 12.6 pg/mL vs 10.82 ± 2.46 pg/mL, P<.001; 37.8 ± 46 pg/mL vs 8.25 ± 3.53 pg/mL, P<.02, respectively). No significant difference in the serum levels of IL-1 (7.2 ± 4.9 pg/mL), TNF- (12.9 ± 3.47 pg/mL), and IL-8 (5.9 ± 4.13 pg/mL) was observed in patients with LV compared with controls. An increased expression of platelet P-selectin was also detected in patients with LV in comparison with controls and patients with CSVV. The mean ± SD percentage of positive cells for P-selectin was 43% ± 5% in the patients with LV, 5.1% ± 2% in the controls (P<.001), and 5.3% ± 2% in the patients with CSVV (P<.001).
Conclusions Taken together, these data demonstrate that different pathogenetic mechanisms are operative in LV and CSVV. In fact, platelet and lymphocyte activation is present in LV, whereas the levels of inflammatory mediators are in a normal range. In CSVV, the high serum levels of proinflammatory cytokines suggest that they are actively involved in the pathogenesis of cutaneous vasculitis.
From the Departments of Dermatology (Drs Papi, Didona, and Cavalieri) and Immunodermatology (Drs De Pità and Frezzolini), Istituto Dermopatico Immacolata, Istituto Ricovero e Cura a Carattere Scientifico, and the Department of Pediatrics, Università Tor Vergata (Drs Di Giulio, De Matteis, and Del Principe), Rome, Italy.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Livedoid Vasculopathy: What Is It?
Joseph L. Jorizzo
Arch Dermatol. 1998;134(4):491-493.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Livedoid Vasculopathy Associated With Plasminogen Activator Inhibitor-1 Promoter Homozygosity (4G/4G) Treated Successfully With Tissue Plasminogen Activator.
Deng et al.
Arch Dermatol 2006;142:1466-1469.
ABSTRACT
| FULL TEXT
Livedoid vasculopathy: what it is and how the patient should be evaluated and treated.
Callen
Arch Dermatol 2006;142:1481-1482.
FULL TEXT
Microangiopathic Ulcers of the Lower Extremities: A Daily Challenge
Papi
INT J LOW EXTREM WOUNDS 2006;5:76-77.
Warfarin Therapy for Livedoid Vasculopathy Associated With Cryofibrinogenemia and Hyperhomocysteinemia
Browning and Callen
Arch Dermatol 2006;142:75-78.
ABSTRACT
| FULL TEXT
Treatment of Livedoid Vasculopathy With Low-Molecular-Weight Heparin: Report of 2 Cases
Hairston et al.
Arch Dermatol 2003;139:987-990.
FULL TEXT
Skin Ulcers Misdiagnosed as Pyoderma Gangrenosum
Weenig et al.
NEJM 2002;347:1412-1418.
ABSTRACT
| FULL TEXT
Isolated digital vasculitis in a patient with rheumatoid arthritis: good response to tumour necrosis factor {alpha} blocking treatment
den Broeder et al.
Ann Rheum Dis 2001;60:538-539.
ABSTRACT
| FULL TEXT
Circulating cytokines and CD30 in normal human pregnancy and recurrent spontaneous abortions
Makhseed et al.
Hum Reprod 2000;15:2011-2017.
ABSTRACT
| FULL TEXT
Prognostic Factors in Leukocytoclastic Vasculitis: What Is the Role of Antineutrophil Cytoplasmic Antibody?
Papi et al.
Arch Dermatol 1999;135:714-715.
FULL TEXT
PURPLE (Oops! Atrophie Blanche) Revisited
Milstone and Braverman
Arch Dermatol 1998;134:1634-1634.
FULL TEXT
Is Livedoid Vasculopathy Really a Vasculitis?
Journal Watch Dermatology 1998;1998:2-2.
FULL TEXT
Livedoid Vasculopathy: What Is It?
Jorizzo
Arch Dermatol 1998;134:491-493.
FULL TEXT
|
