Hemorrhagic vasculitis is fatal. Hemorrhagic vasculitis: symptoms and treatment in children and adults

Systemic aseptic inflammation of the vessels of the microvasculature with a predominant lesion of the skin, joints, gastrointestinal tract and renal glomeruli. It proceeds with symptoms of hemorrhagic or urticarial rash, arthralgia, abdominal pain syndrome, hematuria and renal failure. Diagnostics is based on clinical symptoms, laboratory data (blood, urine, coagulogram), examination of the gastrointestinal tract and kidneys. The mainstay of treatment for vasculitis is therapy with anticoagulants, angiagregants. In severe cases, extracorporeal hemocorrection, glucocorticoid therapy, anti-inflammatory, cytostatic treatment are used.

ICD-10

D69.0 Allergic purpura

General information

Hemorrhagic vasculitis (HB, Schönlein-Henoch disease, allergic purpura, capillary toxicosis) is one of the most common hemorrhagic diseases today. In essence, it is an allergic vasculitis of a superficial nature with damage to small arterioles, venules, and capillaries. In the International Classification of Diseases (ICD), the disease is called "allergic purpura". Schönlein-Henoch disease occurs mainly in childhood - from 5 to 14 years. The average prevalence among children of this age is 23-25 ​​cases per 10 thousand. Persons aged 7-12 years are most susceptible to the disease. In children under 3 years of age, only isolated cases of purpura are known.

Causes

The etiological aspects have not been fully studied, it is only known that in most cases the pathology is of an infectious-allergic nature. There is a seasonal dependence - the highest incidence is recorded in the damp and cold seasons. Long-term observations made it possible to identify common trigger factors that precede the development of clinical manifestations. These include:

• Infectious diseases... In most patients, the manifestation of vasculitis is preceded by an acute infection of the respiratory tract (tracheobronchitis, tonsillitis, rhinopharyngitis). Most often, β-hemolytic streptococcus, Staphylococcus aureus, Escherichia coli, adenovirus, HSV types 1 and 2 can be isolated from nasopharyngeal swabs. A minority of sick children are infected with cytomegalovirus, Epstein-Barr virus, chlamydia, mycobacterium tuberculosis, hepatitis B virus.
• Drug therapy... In rheumatology, there are reports of the development of hemorrhagic vasculitis against the background of the use of pharmacological agents: antibiotics (penicillins, macrolides), NSAIDs, antiarrhythmic agents (quinidine). The phenomena of allergic purpura can be provoked by prophylactic vaccination carried out immediately after an acute respiratory viral infection.
• Allergic burden... In the history of patients with hepatitis B, there are often indications of the presence of various types of allergies (medication, food, cold). Patients often suffer from allergic dermatitis, hay fever, allergic rhinitis, or manifestations of exudative-catarrhal diathesis.
• Other endogenous and external causes... Hypothermia, excessive insolation, insect bites, and trauma can be among the producing factors. In some patients, the manifestation of the disease occurs against the background of pregnancy, diabetes mellitus, malignant tumors, and cirrhosis of the liver.

In many cases, the causative factor that caused the onset of vasculitis has not been established. A number of authors suggest that the effect of provoking factors leads to the development of hemorrhagic vasculitis only when it is carried out against the background of the body's genetic predisposition to hyperergic immune reactions.

Pathogenesis

The mechanism of development of hemorrhagic vasculitis is based on the formation of immune complexes and an increase in the activity of proteins of the complement system. Circulating in the blood, they are deposited on the inner surface of the wall of small vessels (venules, arterioles, capillaries), causing its damage with the occurrence of an aseptic inflammatory process. Inflammation of the vascular wall, in turn, leads to an increase in its permeability, deposition of fibrin and thrombotic masses in the lumen of the vessel, which determines the main clinical signs of the disease - skin-hemorrhagic syndrome and microthrombosis of the vascular bed with damage to the gastrointestinal tract, kidneys, joints.

Classification

In the clinical course of capillary toxicosis, an acute phase (initial period or exacerbation) and a phase of subsiding (improvement) are distinguished. According to the prevailing symptoms, the disease is classified into the following clinical forms: simple, rheumatoid (articular), abdominal and fulminant. In accordance with the nature of the course, acute (up to 2 months), protracted (up to six months) and chronic hepatitis B are distinguished. According to the severity of clinical manifestations, vasculitis is distinguished:

• Light degree... The patients are in a satisfactory condition and the rash and arthralgia are not abundant.
• Medium... The patient's condition is moderate, the rash is abundant, arthralgias are accompanied by changes in the joints of the type of arthritis, periodic abdominal pain and microhematuria are noted.
• Severe degree... There is a serious condition of the patient, draining profuse rashes with necrotic areas, angioedema, nephrotic syndrome, gross hematuria and gastrointestinal bleeding are observed, and acute renal failure may develop.

Symptoms

For the clinic of allergic purpura, an acute onset is typical with an increase in temperature to subfebrile or febrile numbers. However, there may be no temperature rise. Skin syndrome is noted at the very onset of the disease and is observed in all patients. It is characterized by diffuse maculopapular hemorrhagic elements of various sizes (usually small) that do not disappear when pressed. In some cases, a urticarial rash is observed. The rash is usually located symmetrically on the skin of the legs, thighs and buttocks, in the area of ​​large joints, less often on the skin of the arms and trunk. The abundance of rashes is often correlated with the severity of vasculitis. With its most severe course, necrosis develops in the center of some elements of the rash and an ulcer forms. Resolution of the rash results in persistent hyperpigmentation. In the chronic course of hepatitis B with frequent relapses, peeling occurs on the skin after the rash disappears.

Articular syndrome develops in 70% of patients. Joint lesions can be short-term in the form of mild arthralgia or persist for several days with severe pain syndrome, accompanied by other symptoms of arthritis (redness, swelling) and leading to limited movement in the joint. Typical is the volatile nature of the lesion with the involvement of predominantly large joints, more often the knee and ankle. Articular syndrome may appear in the initial period of vasculitis or occur later. It is often transient and never leads to permanent deformity of the joints. Abdominal syndrome may precede or accompany skin-articular manifestations. It manifests itself with abdominal pain of varying intensity - from mild to paroxysmal, like intestinal colic. Patients often cannot indicate the exact location of pain, complain of stool disturbances, nausea and vomiting. Abdominalgias can appear several times during the day and go away spontaneously or in the first few days of treatment.

Renal syndrome occurs in 25-30% of patients and is manifested by signs of chronic or acute glomerulonephritis with varying degrees of hematuria. A number of patients develop a nephrotic symptom complex. The defeat of other organs in hemorrhagic vasculitis occurs quite rarely. It can be hemorrhagic pneumonia in the form of cough with blood streaks in sputum and shortness of breath, hemorrhage in the endocardium, hemorrhagic pericarditis, myocarditis. The defeat of the cerebral vessels is manifested by dizziness, irritability, headache, epileptic seizures and can cause the development of hemorrhagic meningitis.

Complications

Kidney damage is the most persistent syndrome of hemorrhagic vasculitis; it can be complicated by malignant glomerulonephritis and chronic renal failure. In severe cases of allergic purpura, gastrointestinal bleeding occurs, accompanied by bloody vomiting and the presence of blood in the stool, pulmonary hemorrhage, hemorrhage in the brain substance (hemorrhagic stroke). Massive blood loss can lead to collapse and anemic coma. Complications of the abdominal syndrome are less common and are represented by intestinal intussusception, peritonitis, mesenteric thrombosis, and necrosis of a part of the small intestine. The highest frequency of deaths is recorded with fulminant form of hepatitis B.

Diagnostics

When conducting diagnostics, the rheumatologist takes into account the patient's age, studies etiofactors, compares clinical and laboratory data, and excludes other diseases. With the development of renal syndrome, the patient needs a consultation with a nephrologist, in the presence of abdominal pain - consultation with a gastroenterologist and a surgeon. The diagnostic panel includes:

• Hematological tests... In the general analysis of blood, as a rule, nonspecific signs of moderate inflammation (leukocytosis and a slight increase in ESR), an increase in the number of platelets and eosinophils are noted. A biochemical blood test shows an increase in immunoglobulin A and CRP. The results of the coagulogram are of great diagnostic value. The lack of data in it for a coagulation disorder in the presence of clinical signs of hemorrhagic syndrome testifies in favor of hepatitis B.
• Urine and feces tests. In the analysis of urine, hematuria, proteinuria, cylindruria are detected. Patients with renal syndrome are shown monitoring changes in urine analysis, performing urine biochemistry, Zimnitsky's and Nechiporenko's samples. To diagnose latent gastrointestinal bleeding, feces are analyzed for occult blood.
• Instrumental diagnostics... In order to assess the state of the target organs, ultrasound of the kidneys, USDG of the renal vessels are performed. To exclude organic causes of bleeding from the digestive tract and bronchi, it is advisable to carry out ultrasound of the abdominal cavity, gastroscopy, bronchoscopy.
• Biopsy with histology... In severe diagnostic cases, a skin or kidney biopsy is indicated. Histological examination of the biopsy specimen reveals characteristic changes: deposits of immunoglobulin A and CEC on the endothelium and in the thickness of the vascular wall of venules, arterioles and capillaries; the formation of microthrombi; exit of blood elements outside the vessel.

The abdominal form of hemorrhagic vasculitis should be differentiated from other causes that cause the appearance of symptoms of "acute abdomen": appendicitis, penetration of a stomach ulcer,

• For any syndromes... The basis of basic therapy for all forms of hepatitis B is the appointment of antiplatelet agents (dipyridamole, pentoxifylline) and fibrinolysis activators (nicotinic acid). The drugs of these groups prevent platelet aggregation, improve microcirculation and interstitial perfusion. Often, heparin and other anticoagulants are included in the basic regimen.
• With skin syndrome. Therapy involves the use of sulfasalazine, colchicine. The use of prednisone is still a controversial issue among physicians. Perhaps its appointment in severe cases of hepatitis B. In the absence of the effect of corticosteroid therapy, the reserve drugs are cytostatics.
• With articular syndrome... Severe arthralgias are relieved by anti-inflammatory therapy (indomethacin, ibuprofen). Additionally, derivatives of aminoquinoline (chloroquine) may be prescribed.
• With renal syndrome... High doses of glucocorticoids and cytostatics are prescribed. It is possible to use an ACE inhibitor, angiotensin II receptor antagonists, the introduction of normal human immunoglobulin, electrophoresis with nicotinic acid and heparin on the kidney area. In end-stage chronic renal failure, hemodialysis or kidney transplantation is required.
• With abdominal syndrome... Intense pain syndrome is an indication for intravenous administration of prednisone, rheopolyglucin, crystalloids. With the development of surgical complications (perforation, intussusception of the intestine), surgical tactics are used.

A severe course of the disease is an indication for extracorporeal hemocorrection (hemosorption, immunosorption,). Many authors note the ineffectiveness of antihistamines in the treatment of hepatitis B. However, their use can be justified in patients with an allergic history. When the disease is associated with food allergy and the presence of an abdominal syndrome, enterosorbents are additionally prescribed.

Forecast and prophylaxis

Mild forms of hemorrhagic vasculitis are prone to spontaneous healing after the first attack of the disease - their prognosis is favorable. With a fulminant form, the death of patients can occur in the first few days from the onset of the disease. Most often this is due to damage to the vessels of the central nervous system and the occurrence of intracerebral hemorrhage. Another cause of death can be severe renal syndrome, leading to the development of uremia. In order to prevent allergic vasculitis, it is recommended to sanitize chronic infectious foci of ENT organs, deworming for helminthic invasions, excluding contact with known allergens and uncontrolled intake of medications.

Hemorrhagic vasculitis is a disease manifested by purple rashes on the surface of the skin and mucous membranes. It is most often diagnosed in children aged 5 to 13 years, but it is often diagnosed in adults. In the absence of therapy, chronic renal failure may develop. Specialists continue to study the disease, since the exact reasons for its development have not yet been established and methods of treatment have not been developed.

Scientists continue to argue what triggers the development of hemorrhagic vasculitis and why it develops. Based on the research, a number of factors have been identified that have an impact. These include:

1. Previously transferred viral or infectious diseases. Inflammation of the respiratory tract, which occurs in acute or chronic form, is of particular importance. Influenza, tonsillitis, SARS, tonsillitis, chickenpox, measles can become provocateurs.
2. Damage to the walls of blood vessels or the upper layer of the epidermis.
3. Allergy to a component of drugs, food.
4. Prolonged exposure to ultraviolet rays, radiation, high or low temperatures.
5. Poisoning with chemicals, toxins.
6. Insect bite when there is a strong reaction of the body.
7. Malignant and benign neoplasms.
8. Violation of hormonal levels during pregnancy, thyroid diseases, diabetes mellitus.

Also, many patients with diagnosed hemorrhagic vasculitis have a genetic predisposition. The disease can develop with a weakened immune system. Among adults, older people are most often affected.

Clinical picture

The main symptom is the appearance of a rash. The elements of the rash are usually purple in color and can be different:

• Small blisters of bright red color.
• Small bruises.
• Nodules.
• Red papules. Formed mainly on the mucous membranes of the oral cavity.
• Papules, pale when pressed.

The diameter of the rashes is not more than 1 cm. After 4 days after the appearance, they begin to fade and completely disappear. Reappears after 7-10 days.

The rash is initially localized on the surface of the feet and legs, then spreads throughout the body.

Other symptoms of vasculitis include:

• redness
• painful sensations when moving

The pain is often migratory in nature. The intensity can also be different: from mild discomfort to inflammation accompanying swelling. The pain continues for several hours.

More information about the causes of vasculitis can be found in the video:

From the side of the digestive tract are observed:

• Nausea, often accompanied by vomiting.
• Colic in the abdomen.
• Bleeding of the intestinal mucosa, as a result of which blood is found in the feces.

Anemic syndrome with hemorrhagic vasculitis is expressed:

• Dizziness.
• Recurrent headaches.
• General weakness and malaise.
• Fainting.
• The appearance of "flies" before the eyes.
• Noise in the ears.

All signs appear within 1-3 weeks after the rash. In rare cases, the pathology proceeds in an isolated form. In some cases, the respiratory system is affected. This causes shortness of breath and cough. Sputum contains blood impurities.

Classification

Hemorrhagic vasculitis, depending on the manifestations and the results of laboratory tests, is usually divided into three degrees:

1. The first degree is characterized by a satisfactory condition of the patient. Body temperature does not exceed 37 degrees. The rash is moderate and not spread over large areas of the skin. When examining blood, ESR is not more than 20mm / hour. There are no other manifestations.
2. The second degree is characterized by a moderate condition. The rash is intense. The temperature rises up to 38 degrees. Patients complain of headaches, weakness, and intoxication of the body is observed. Examination reveals articular and renal syndromes, which are moderately expressed. ESR is up to 40 mm / hour.
3. In the third degree, the patient's condition is assessed as severe. The temperature is always high, the symptoms of intoxication are pronounced. Skin, renal, articular syndromes are manifested. In some cases, brain damage is possible. In a laboratory study of blood, leukocytosis is established, a decrease in the level of hemoglobin, an ESR of more than 40 mm / hour.

In addition, depending on the area of ​​localization of the pathological process, several different forms of the disease are distinguished, depending on. These include:

• Dermal. Also called simple. Rashes appear only on the surface of the skin in different areas.
• Skin and articular. In addition to the rash, joint damage is observed.
• Skin and abdominal. It is joined by a violation of the intestines, the function of the walls of the stomach.
• Renal. One of the rare forms. The lesion of the urinary system is characterized.

They also distinguish between mixed and lightning-fast forms. Depending on the degree and form of the disease, a specific course of treatment is prescribed. In some cases, urgent hospitalization may be required.

Diagnostics

First of all, the doctor examines and assesses the extent of the spread of the rash. Then he carefully examines the patient's history, prescribes diagnostic examinations.

If hemorrhagic vasculitis is suspected, the main research methods are:

1. Blood chemistry. It is carried out to determine the content of protein compounds.
2. General blood analysis. It is necessary to study the leukocyte formula.
3. Determination of circulating immune complexes.
4. Detection of class A immunoglobulins.
5. Coagulogram.

Based on the results of laboratory tests, the degree and form of the disease is established, and the course of therapy is determined. In some cases, the patient needs the advice of other specialists.

Treatment and prognosis

The main objective of the treatment of hemorrhagic vasculitis is to relieve symptoms and alleviate the patient's condition. There is no specific therapy regimen, but experts are studying this issue.

When diagnosing a disease, the following are prescribed:

• Disaggregants. The most effective is Curantil. In severe cases, "Trental" is administered intravenously.
• "Heparin". Intravenous or subcutaneous. Over time, the drug is gradually canceled.
• Fibrinolysis activators. This group includes nicotinic acid.
• In case of a severe condition, plasmapheresis or a course of glucocorticosteroids is prescribed.
• Cyclophosphamide or Azathioprine are rarely used. In the presence of severe painful sensations, pain relievers such as Ibuprofen are indicated. It helps relieve inflammation, reduce fever, and relieve pain.

The duration of treatment depends on the degree of development of the disease. In the first degree, it can be from 2 to 3 months. With an average - up to six months. In the case of a severe course, the duration of therapy can be up to 1 year. Pathology is accompanied by relapses.

To date, there are no drugs that can suppress the pathological process, regardless of its location, which complicates the treatment of hemorrhagic vasculitis.

With correct and timely therapy, the prognosis is favorable.

Fatal outcome is rarely diagnosed, in the case of an acute pathology and the presence of complications from the gastrointestinal tract. Death occurs with renal failure and damage to the nervous system.

In some patients, after undergoing a course of treatment, chronic kidney pathologies are established. In a quarter of patients, a sediment remains in the urine for five years. To date, the final outcome of vasculitis in these patients is not known.

Complications and preventive measures

Hemorrhagic vasculitis is a dangerous and rapidly progressive disease. Lack of therapy can lead to serious consequences. They appear as:

• functional disorders of the heart muscle and liver
• pulmonary bleeding
• peritonitis
• intestinal obstruction
• renal failure
• anemia
• diathesis

There are no specific methods for preventing hemorrhagic vasculitis. Doctors recommend following general preventive measures:

1. Avoid strenuous physical activity.
2. Do not overcool the body.
3. Treat various infectious diseases in a timely manner.
4. Strengthen immunity.

Scientists continue to study the nature and treatment of the disease. Lack of therapy in the event of symptoms of vasculitis can be fatal as a result of cerebral hemorrhage. That is why you should be attentive to your health and consult a doctor on time.

Hemorrhagic vasculitis is a primary systemic disease that mainly affects young people. The disease manifests itself in the form of arthralgia, microthrombosis, palpable purpura and malfunctions of the stomach and intestines. The disease proceeds with frequent relapses, in some cases renal failure may develop. Pathology has been studied by scientists for a long time, but there is still no exact data on the etiology, pathogenesis and methods of therapy. In addition, there is also no precise classification, so the topic is difficult to cover. Let's figure out how hemorrhagic vasculitis looks in the photo in adults, which treatment is better to carry out - traditional methods or folk?

What provokes the development of the disease?

Vasculitis manifests itself against the background of inflammatory processes in the walls of blood vessels. After a short period of time, the permeability of small blood vessels increases, and fibrin and thrombotic masses are deposited in these lumens. As a result, microthrombi appear and one of the names of such a pathology is capillarotoxicosis.

The defeat of small joints is not as dangerous as the pathology that affected the veins and arteries. The main thing is to determine exactly what are the causes of hemorrhagic vasculitis in adults, and then the treatment will be selected as accurately as possible. The main provoking factors in the development of pathology, doctors distinguish the following:

Some scientists still believe that there is a high risk of disease in those who have a predisposition to certain types of immune responses. In most cases, school-age children are sick, but only a few cases of the disease have been recorded in infants.

We have determined what are the causes of hemorrhagic vasculitis in adults, treatment will be effective after the classification of the disease is clarified.

Classification of pathology

There are several clinical forms of the disease:

• lightning fast;
• cutaneous;
• rheumatoid;
• renal;
• abdominal;
• mixed.

The nature of the pathology can be divided into several types:

• acute - lasts up to two months;
• protracted - lasts up to 6 months;
• chronic - a long period, accompanied by relapses, remission and exacerbations.

There are several degrees of hemorrhagic vasculitis, treatment in adults will be effective only after their accurate determination:

1. Lightweight. In this case, the patient's condition does not cause serious concern, the rash on the body is rare, small foci, accompanied by minor pain in the joints.
2. Average. The general condition of the patient deteriorates significantly, the skin becomes covered with a profuse rash, the joints are strongly twisted, from time to time there are pains in the peritoneum.
3. Heavy. Weakness throughout the body, angioedema, rashes cover most of the body, ulcers appear in some places, there may be bleeding in the stomach and intestines, and renal failure develops.

What does hemorrhagic vasculitis look like?

Hemorrhagic vasculitis begins to develop, the treatment of which in adults is selected individually, with a common skin rash. These are small and symmetrically located small bruises that do not disappear if you press on them.

In addition, it should be noted:

• rashes can appear near the joints or on the buttocks;
• rashes provoked by the development of hemorrhagic vasculitis (treatment in adults requires a special approach) rarely appear on the skin of the face, trunk and palms;
• the intensity of rashes can be different - from single foci to massive ones with their subsequent merging;
• during the extinction of the disease, pigmentation remains on the skin, peeling is periodically noticeable in its place.

Clinical manifestations

The clinical manifestations of the symptoms of hemorrhagic vasculitis depend on the severity of the course of the disease and the localization of inflammatory processes. Treatment of the disease is individual. Pathology begins to develop sharply and is accompanied by an increased body temperature up to febrile numbers. In rare cases, the temperature may not be present.

In addition, the disease is characterized by skin rashes of various sizes. In rheumatology, the symptoms of hemorrhagic vasculitis may differ (we will consider the treatment a little later).

1. Skin syndrome... This form manifests itself sharply and is accompanied by a high temperature; diffuse spots with hemorrhagic elements are noticeable on the skin. Most often, the rash appears on the legs, buttocks, thighs, mainly in the joints. In rare cases, it can be localized on the limbs and trunk. In severe cases, the rash can develop into necrosis, and small ulcers appear. With a chronic form and a long course of pathology, peeling appears on the skin.
2. Articular syndrome... This type occurs in 70% of patients with hemorrhagic vasculitis, symptoms and treatment may differ in patients. But most often this type is accompanied by joint pain with the development of an inflammatory process. Large joints are mainly affected. In addition to inflammation, there is swelling with disorders of the musculoskeletal system. This syndrome can manifest itself early in the disease or during progression. If therapy is started on time, the joints will not atrophy.
3. It is most often manifested in children with hemorrhagic vasculitis. Treatment (parental reviews confirm this) gives good results if it is timely. The syndrome is accompanied by pain in the peritoneum of varying intensity, which is present in every part of the stomach and intestines. In addition to pain, there is: nausea, vomiting, constipation, diarrhea and flatulence. In severe cases, gastric and intestinal bleeding may occur without timely treatment.
4. Renal Syndrome. It is observed in only 25% of patients. It is accompanied by signs of acute glomerulonephritis with hematuria or nephrotic syndrome. These symptoms lead to kidney failure and can be dangerous to humans.

In addition to the main symptoms, the disease causes general intoxication, lack of appetite, urinary retention.

In adults, the treatment of hemorrhagic vasculitis should be timely, because it can affect other organs, causing the following symptoms:

• hemorrhagic pneumonia, which manifests itself as a cough with sputum streaked with blood;

• hemorrhagic myocarditis with vascular and heart damage;
• hemorrhagic meningitis affects the vessels of the brain, accompanied by headache, irritability, seizures, cerebral hemorrhages, which leads to stroke and disability.

The symptomatology of the disease is pronounced and requires an urgent visit to a doctor and the selection of individual treatment depending on the manifestations and syndrome.

Diagnostic methods

We examined the causes of hemorrhagic vasculitis in adults. The prognosis, treatment of such a disease may differ in different patients, it is necessary to urgently consult a doctor who will prescribe a comprehensive examination.

The main diagnostic methods are:

• coagulogram;
• identification;
• determination of immunoglobulins, cryoglobulins and components of the complement systems;
• biochemical analysis;
• general detailed blood test with the calculation of the leukocyte formula.

Treatment of hemorrhagic vasculitis

Therapy for vasculitis should be comprehensive, consisting of therapeutic and drug techniques. Traditional medicine can be added to the main methods. In rare cases, surgery may also be required.

Therapeutic treatment consists of general wellness treatments. You can follow a hypoallergenic diet, limit physical activity, but exercise therapy is needed.

From hardware techniques, plasmapheresis can be prescribed. This procedure allows you to cleanse the blood of toxins, microbes and other harmful substances. But without taking medication, it will not be possible to cure the disease.

As for taking medications, with hemorrhagic vasculitis, they are prescribed:

• non-steroidal anti-inflammatory drugs that help relieve inflammation and lower body temperature;
• membrane stabilizing agents, they help to restore the tissues affected by the disease;
• cytostatics restore immunity;
• antacids to help reduce the risk of stomach damage;
• antispasmodics help reduce pain.

In addition, with hemorrhagic vasculitis of the skin form, treatment in adults requires taking other groups of drugs, the choice of which depends on concomitant pathologies and the presence of chronic ailments.

Surgery is rarely used in the treatment of hemorrhagic vasculitis, mainly in cases where the intestines and kidneys are severely affected. In this case, the affected areas of the intestine are removed or a kidney transplant is performed.

Treatment of cutaneous hemorrhagic vasculitis is carried out locally, for this ointments are used:

• aceminic;
• dibunol;
• venorutonic;
• Solcoseryl.

These funds help restore the elasticity and density of the vessel walls. In case of ulcerative erosive manifestations, other ointments are recommended: Vishnevsky, Mikulich or Iruksol.

Besides traditional treatments, traditional medicine is also effective.

Hemorrhagic vasculitis: treatment with folk remedies

Effective grandma's recipes:

• Take three tablespoons of field ivy and elderflower flowers, add one and a half tablespoons of mint and the same amount of yarrow to them. Mix everything thoroughly and take 60 grams of collection, pour 0.5 liters of hot, slightly cooled water and leave to brew for 12 hours. Take the broth for ½ cup 5 times a day. Also, this broth can be used as lotions on damaged skin areas, apply a cloth soaked in the broth for 20 minutes.
• Mix together Mountain Arnica, Calendula and Japanese Sophora. Take 10 grams of collection and pour a glass of boiling water, leave for three hours, and then strain and drink 1 tablespoon every 8 hours.
• You can prepare an alcoholic tincture, for this you need to grind three large lemons, add 5 tablespoons of cloves, two glasses of sugar and 0.5 ml of medical alcohol. Insist for two weeks, and then take 1 tablespoon before each meal.
• You can prepare your own ointment for the treatment of hemorrhagic vasculitis. It is prepared like this: grind 200 grams of birch buds into powder and mix with kilograms of nutria fat. After the mixture is sent to the oven for three hours, repeat this throughout the week, and then strain and lubricate the affected areas.

It is easy to treat hemorrhagic vasculitis with folk remedies. Alternative treatment will be effective only if the intestines are cleaned. To do this, you can use the following infusion: take 40 grams of the collection, which contains elecampane, tansy, immortelle and wormwood, pour a liter of hot water. Leave for two hours, and then strain. It is necessary to drink the broth on an empty stomach, while adding water in a 1: 1 ratio. Take twice a day.

You should also cleanse the blood. To do this, you need to prepare an infusion of thick-leaved bergenia. Dry leaves are poured over with boiled water, infused overnight and in a strained form is taken ½ cup on an empty stomach.

Complications

It is worth remembering that if you do not immediately take any measures and do not treat hemorrhagic vasculitis, then the complications can be much more serious than it seems:

• intestinal obstruction;
• pancreatitis;
• perforation of ulcers in the intestines and stomach;
• peritonitis;
• posthemorrhagic anemia;
• thrombosis and heart attacks;
• neuritis and cerebral disorders.

Complications occur in patients who did not seek help in a timely manner.

Preventive methods

After the patient has undergone a course of treatment, he is recommended to adhere to certain recommendations - preventive measures, only in this case there will be no relapses. Doctors recommend to their patients:

• adhere to a hypoallergenic diet, it is strictly forbidden to consume chocolate, citrus fruits, eggs and nuts;
• refuse vaccination and various tests with bacterial antigens;
• exclude all physiotherapy;
• take antibacterial agents only in the most extreme cases;
• treat infections on time;
• regularly undergo examination for the presence of helminthic invasions;
• avoid hypothermia and overheating;
• visit a doctor regularly;
• limit yourself to physical activity, but physiotherapy exercises are even encouraged;
• avoid contact with chemicals.

Inaction prognosis for hemorrhagic vasculitis

The initial stages of the disease in some patients may pass on their own, but in other cases, if appropriate measures are not taken, the disease can be fatal. The fulminant form can lead to the death of the patient, and all because the central nervous system is affected and a cerebral hemorrhage occurs.

If the disease is detected in time and treatment is started, then half of the patients experience a speedy recovery, and the second half may have relapses, but only if they repeatedly encounter the cause that provoked the development of the disease.

Drugs for the treatment of cutaneous vasculitis: heparin, askorutin, Chinese plaster (recommendations of a dermatologist) - video

Treatment of cutaneous vasculitis in children and pregnant women. Diet, fasting, treatment with folk remedies (recommendations of a dermatologist) - video

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Diagnosis of skin vasculitis

Diagnostics vasculitis skin based on the external examination and palpation of the rash by the doctor. In addition, the doctor asks a person for information about past infections, taking medications, episodes of physical and mental stress, hypothermia, prolonged stay on their feet, etc.

In rare cases, with a persistent course of the disease or with atypical symptoms, when external signs are not obvious, a histological examination of the skin area under a microscope is performed to confirm the diagnosis of vasculitis. The area of ​​skin for examination is taken during the biopsy procedure from the affected area.

After examining and feeling the rashes, the doctor prescribes the following laboratory tests to determine the degree of activity of the pathological process:

• General blood analysis ;
• The content of total protein and its fractions in the blood (albumin and globulins);
• The content of C-reactive protein in the blood;
• Complement system activity;
• Concentration of immunoglobulins in the blood;
• Waaler-Rose reaction;
• Latex test;
• General urine analysis .

Treatment of cutaneous vasculitis

General principles of therapy

The main goal of the treatment for vasculitis is to achieve a stable remission. When choosing a therapy regimen, a specific disease is taken into account, which is part of the vasculitis group, the stage and degree of activity of the pathological process. The medications used should suppress the inflammatory reaction, normalize microcirculation in the skin and eliminate the existing complications resulting from microcirculation disorders. To achieve these effects, external agents and preparations are used for oral administration.

With exacerbations of vasculitis, adherence to bed rest is shown until the transition of the disease to the stage of regression. However, treatment is carried out up to the normalization of laboratory parameters reflecting the degree of activity of the process. Further, for another 6 to 12 months, supportive therapy is carried out aimed at preventing relapse. As a rule, supportive therapy includes a course of taking the same medications that are used for treatment during an exacerbation.

Determination of the degree of activity of vasculitis of the skin

Treatment of skin vasculitis depends on the degree of activity of the process and its clinical form. Therefore, in order to select the correct treatment algorithm, it is first necessary to determine the activity of the pathological process. So, there are two degrees of activity of the pathological process in vasculitis:

• I degree of activity. The skin is affected within limited limits, there is no general symptomatology (fever, headaches, joint pain, general weakness, etc.), the internal organs are not involved in the pathological process, and laboratory parameters are practically within the normal range.
• II degree of activity. The skin is extensively affected, rashes are present in several places, general symptoms are present (headaches, fever, general weakness, etc.) and signs of the involvement of internal organs in the pathological process (pain in muscles and joints, neuropathy, etc.) ...

The degree of activity of the pathological process with vasculitis of the skin is determined by the value of laboratory parameters, reflected in the table below:

Laboratory indicators	The degree of activity of the pathological process
	I degree of activity	II degree of activity
The area of ​​skin lesions (rashes)	Limited eruptions	Common rashes
The number of rashes	Small	Plural
Body temperature	Normal or subfebrile (not higher than 37.5 o C)	Above 37.5 o C
General symptoms (malaise, general weakness, headache, joint pain, muscle pain, etc.)	Absent or slightly pronounced	Pronounced
ESR (erythrocyte sedimentation rate)	Less than 25mm / h	More than 25 mm / h
Total red blood cell count	Within normal limits	Less than 3.8 × 10 12 / l
Hemoglobin	Within normal limits	Less than 12g% (120g / L)
Total platelet count	Within normal limits	Less than 180 × 10 9 / l
The total number of leukocytes	Within normal limits	More than 10 × 10 9 / l
Total protein	Within normal limits	More than 85 g / l
Alpha 2 Globulin	Within normal limits	More than 12%
Gamma globulin	Within normal limits	More than 22%
C-reactive protein	None or before ++	More ++
Complement activity	Above 30 units	Below 30 units
Concentration of immunoglobulins	Within normal limits	Increased
Waaler-Rose reaction	Negative	Positive
Latex test	Negative	Positive
Proteinuria (protein in the urine)	No	There is

Treatment regimens for different types of vasculitis, depending on the degree of activity

Consider the various therapy regimens that are used to treat different forms of skin vasculitis in accordance with the degree of activity of the pathological process. The following treatment regimens are approved and recommended by the Ministry of Health of the Russian Federation.

Various forms of polymorphic dermal vasculitis(utricular, hemorrhagic, papulonodular, papulonecrotic type, etc.) are treated in the same way, and the therapy regimens differ only depending on the degree of activity of the pathological process. The therapy regimens recommended by the Ministry of Health of Russia for the treatment of polymorphic dermal vasculitis are shown in Table 1. The table contains the names of the active substances of drugs, not commercial names. This means that for treatment, you can take any drugs containing these substances as active components.
Table 1 - Treatment regimens for polymorphic dermal vasculitis of I and II degrees of activity.

Treatment regimen for various types of polymorphic dermal vasculitis of I degree of activity	Treatment regimen for various types of polymorphic dermal vasculitis of the II degree of activity
Non-steroidal anti-inflammatory drugs (NSAIDs) (taken orally to relieve inflammation):
	Prednisolone - take 30-50 mg per day in the morning for 2 to 3 weeks. After that, reduce the dosage by 1 tablet per week, up to complete cancellation.
Meloxicam - take 7.5 mg 2 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.
Indomethacin - take 25 mg 3-4 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.	Proton pump inhibitors (taken orally to reduce the severity of side effects of glucocorticoids):
Antibiotics (taken internally to kill germs that cause vasculitis):	Omeprazole - take 20 mg 2 times a day, until the complete cancellation of glucocorticoids.
Ciprofloxacin - take 250 mg 2 times a day for 10 to 14 days.	Micro- and macroelements (taken orally to reduce the severity of side effects of glucocorticoids):
Doxycycline - take 100 mg 2 times a day for 10 to 14 days.	Potassium and magnesium asparaginate (Asparkam, Panangin) - take 1 tablet 3 times a day, until glucocorticoids are completely canceled.
Azithromycin - take 500 mg once a day for 10 to 14 days.	Exchange proofreaders calcium and vitamin D (taken orally to reduce the severity of side effects of glucocorticoids):
	Nimesulide - take 100 mg 2 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.
Antihistamines (taken orally to relieve swelling and itching):	Meloxicam - take 7.5 mg 2 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.
Levocetirizine - Take 5 mg once a day for 2 weeks.	Diclofenac - take 50 mg 3 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.
Desloratadine - Take 5 mg once a day for 2 weeks.	Cytostatics (taken orally to relieve inflammation):
Fexofenadine - Take 180 mg 1 time per day for 2 weeks.	Azathioprine - take 50 mg 2 times a day for 2 to 3 months.
Ointments with glucocorticoids (applied externally to lesions to relieve inflammation):	Antibiotics (taken orally to kill pathogenic microbes that can cause vasculitis):
Mometasone furoate 0.1% (cream, ointment) - apply once a day until improvement occurs.	Ofloxacin - take 400 mg 2 times a day for 10 to 14 days.
Betamethasone 0.1% (cream, ointment) - apply 2 times a day until improvement occurs.	Amoxicillin + clavulanic acid - take 875 + 125 mg 2 times a day for 10-14 days.
Methylprednisolone aceponate 0.1% (cream, ointment) - apply once a day for a maximum of 12 weeks.
	Anavenol - take 2 tablets 2 times a day for 1 to 2 months.
	Antihistamines (taken orally to relieve swelling and itching):
	Ebastine - Take 10 mg once a day for 2 weeks.
	Cetirizine - Take 10 mg once a day for 2 weeks.
	Levocetirizine - Take 5 mg once a day for 2 weeks.
	Trypsin + Chymotrypsin - prepare a solution from a lyophilisate, and make applications from it to remove pus and necrotic masses.
	Levomekol is an ointment for relieving inflammation.
	Silver sulfathiazole 2% cream - for cleansing wounds.
	Solcoseryl is an ointment to accelerate healing.

For the treatment of all types of chronic pigmentary purpura and I and II degrees of activity, the following drugs are recommended:

1. Quinolines (taken orally to kill the germs that cause vasculitis):

• Hydroxychloroquine - take 200 mg 2 times a day for 2-3 months;
• Chloroquine - take 250 mg 2 times a day for a month, then 250 mg once a day for 1 to 2 months.

2. Vitamins (taken orally to normalize microcirculation and strengthen the vascular wall):

• Ascorbic acid + Rutozid - take 1 tablet 3 times a day for 3 - 5 months;
• Vitamin E + Retinol - take 2 capsules 2 times a day for 3 - 5 months.

3. Angioprotectors and microcirculation correctors (taken orally to strengthen the vascular wall and in case of microcirculation disorders):

• Pentoxifylline - take 100 mg 3 times a day for 1 - 2 months;
• Dipyridamole - take 25 mg 3 times a day for 1 to 2 months.

4. Venotonics and venoprotectors (taken orally to strengthen the walls of the veins):

• Hesperidin + Diosmin - take 500 mg 2 times a day for 1 - 2 months.

5. External remedies (applied to lesions to accelerate healing, cleanse wound surfaces, relieve inflammation, etc.):

• Mometasone furoate 0.1% (cream, ointment to relieve inflammation) - apply once a day to the lesions until improvement occurs;
• Betamethasone 0.1% (cream, ointment for relieving inflammation) - apply 2 times a day to the lesions until improvement occurs;
• Methylprednisolone aceponate 0.1% (cream, ointment to relieve inflammation) - apply once a day to the lesions for no more than 12 weeks;
• Troxerutin 2% gel (to improve vascular tone) - apply 2 times a day;
• Heparin sodium ointment (to normalize microcirculation and accelerate healing) - apply 2 to 3 times a day until improvement occurs (on average 3 to 14 days).

Treatment regimens for livedo angiitis of I and II degrees of activity recommended by the Ministry of Health of Russia are shown in Table 2. The table contains the names of the active substances of medicinal products, not commercial names. This means that for treatment, you can take any drugs containing these substances as active components.

Table 2 - Treatment regimens for livedo-angiitis of I and II degrees of activity.

Treatment regimen for livedo angiitis of the 1st degree of activity	Treatment regimen for livedo angiitis of the II degree of activity
Non-steroidal anti-inflammatory drugs (NSAIDs) (taken orally to relieve inflammation):	Systemic glucocorticoids (taken orally or intravenously to control inflammation):
Nimesulide - take 100 mg 2 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.	Prednisolone - take 30-50 mg per day in the morning for 2 to 3 weeks. After that, reduce the dosage by 1 tablet per week, up to complete cancellation.
Diclofenac - take 50 mg 3 times a day for 2 to 3 weeks. Further, the dosage is reduced by half, and the drug is taken until remission occurs.	Betamethasone - inject 2 ml of solution intramuscularly once a week for 3 - 5 weeks. After that, the dose is reduced by 25% weekly, until the drug is completely discontinued.
Quinolines (taken orally to kill the germs that cause vasculitis):	Proton pump inhibitors (taken orally to reduce the side effects of glucocorticoids):
Hydroxychloroquine - take 200 mg 2 times a day for 2 to 3 months.	Omeprazole - take 20 mg 2 times a day, until the complete cancellation of glucocorticoids.
Chloroquine - take 250 mg 2 times a day for a month, then 250 mg 1 time a day for 1 to 2 months.	Micro and macronutrients (taken orally to reduce the severity of side effects of glucocorticoids):
Angioprotectors and microcirculation correctors (taken orally to normalize microcirculation):	Potassium and magnesium asparaginate (Asparkam, Panangin) - take 1 tablet 3 times a day, until glucocorticoids are completely canceled.
Pentoxifylline - take 100 mg 3 times a day for 1 to 2 months.	Correctors of calcium and vitamin D metabolism (taken orally to reduce the severity of side effects of glucocorticoids):
Anavenol - take 2 tablets 2 times a day for 1 to 2 months.	Calcium carbonate + cholecalciferol take 1 tablet 3 times a day, until glucocorticoids are completely canceled.
Venotonic and venoprotective agents (taken orally to strengthen the vascular wall):	Cytostatics (taken orally to relieve inflammation):
Hesperidin + Diosmin - take 500 mg 2 times a day for 1 - 2 months.	Azathioprine - take 50 mg 2 times a day for 2 to 3 months.
Vitamins (taken orally to strengthen the vascular wall and improve microcirculation):	Angioprotectors and microcirculation correctors (taken orally to normalize microcirculation):
Ascorbic acid + Rutozid - take 1 tablet 3 times a day for 3 to 5 months.	Pentoxifylline - take 100 mg 3 times a day for 1 to 2 months.
Vitamin E + Retinol - take 2 capsules 2 times a day for 3 - 5 months.	Anticoagulants (given by injection to dissolve blood clots):
	Nadroparin calcium - injected subcutaneously, 0.3 ml, 2 times a day for 2 to 4 weeks.
	Detoxification therapy (administered intravenously to remove toxic substances from the blood):
	Dextran - inject 200-400 ml intravenously, once a day for 7-10 days.
	External remedies (applied externally to the affected area to relieve inflammation, cleanse ulcers from pus and necrotic masses, and also heal):
	Troxerutin 2% gel (to improve vascular tone) - apply 2 times a day.
	Betamethasone + glucocorticoids that relieve inflammation (Betamethasone, Dexamethasone, etc.); Ointments for cleansing ulcers and erosions from pus and necrotic masses (Silver sulfathiazole 2%, Iruksol, Himopsin, etc.); Applications with Dimexidum to accelerate healing and relieve inflammation. Cutaneous vasculitis: treatment (hemorrhagic, urticarial, etc.). Contraindications for vasculitis - video Drugs for the treatment of cutaneous vasculitis: heparin, askorutin, Chinese plaster (recommendations of a dermatologist) - video Treatment of cutaneous vasculitis in children and pregnant women. Diet, fasting, treatment with folk remedies (recommendations of a dermatologist) - video

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Hemorrhagic vasculitis (Schönlein-Henoch purpura), along with hereditary vasopathy (), congenital vascular tumors (), is considered a pathological condition related to hemorrhagic diathesis, which are caused by damage to the walls of blood vessels. The forms are different, but the basis of the symptoms is the same - hemorrhagic syndrome, manifested by cutaneous hemorrhages, bleeding of mucous membranes and hemorrhages in tissues and organs.

Hemorrhagic vasculitis is an immunocomplex disease, therefore it is also called hemorrhagic immune microthrombovasculitis or anaphylactoid purpura, which differs from the absence of hemolysis and itself.

What happens to the vascular walls, why this disease occurs, how it manifests itself and is treated - questions that worry many, since it is quite widespread, especially among the children's population of the planet.

What causes damage to the vascular walls in hemorrhagic vasculitis?

With hemorrhagic vasculitis in vessels of small diameter, the so-called "aseptic inflammation" occurs, which (with the participation of the complement system) is accompanied by the formation of immune complexes circulating in the bloodstream (CIC), repeated thrombosis of blood vessels and destructive disorders in their wall. However, this reaction must start somewhere.

To date, the main The causes of hemorrhagic vasculitis are considered:

1. A bacterial (mainly streptococcal) or viral infection transferred the day before;
2. Allergic mood of the body;
3. Vaccination (any vaccinations);
4. The use of medicines;
5. Passion for certain foods;
6. Helminthic invasion;
7. Exposure to low temperatures (frost, cold wind);
8. The presence of foci of chronic inflammation;
9. Children's age (the greatest chance of getting sick occurs in children between 5 and 10 years of age);
10. Hereditary predisposition;
11. The presence of immunopathological or allergic diseases in relatives.

In the case of a combination of all or several factors, the risk of HS formation increases markedly.

Formed in hemorrhagic vasculitis, the CECs contain immunoglobulins of classes A and G, with IqA occupying about 80%, and IqG about 20% of cases. Hemorrhagic vasculitis with the IqG variant has a more severe course, as it goes with the development of renal pathology, and, accordingly, with a worsening prognosis.

Video: causes of vasculitis

Systemic vasculitis - a wide range of diseases

Pathological conditions accompanied by hemorrhagic syndrome are often so similar in their symptoms that even a doctor can find it difficult to immediately determine whether it is primary hemorrhagic vasculitis or a syndrome that has arisen against the background of rheumatoid arthritis, infectious or SLE (systemic lupus erythematosus). In this case, important importance is attached to the age of the patient, because it is known that some types of vasculitis occur more often in children, while in adults other variants prevail, which are formed against the background of "adult" pathology.

In order not to get confused in vasculitis, it should be said that hemorrhagic vasculitis is a systemic disease. And this is a whole group, which is characterized by systemic vascular lesion, accompanied by an inflammatory reaction of their walls. In addition to the hemorrhagic vasculitis itself, typical representatives of this group include:

• (damage to arteries, mainly of small and medium caliber);
• (granulomatous-necrotic lesion of the respiratory and kidney organs);
• (the carotid, temporal and cranial arteries are mainly affected, therefore, cerebral symptoms are very characteristic of the disease);
• (capillaritis, flowing like hemorrhagic pneumonitis or nephritis, since in most cases the vessels of the lungs and kidneys are affected);
• (Buerger's disease);
• Moshkovich syndrome ();

This is a group of primary vasculitis, however, there are also secondary ones that arise against the background of infectious, allergic and other processes, that is, they complicate another disease and go like a syndrome. For example, hemorrhagic vasculitis is accompanied, but the underlying disease is still considered SLE, which determines the tactics of treatment. However, the GW itself does not differ in the flow of the same type; therefore, it is hardly possible to do without its classification.

How to classify GW: by its shape, course, or mechanism of occurrence?

The types of hemorrhagic vasculitis differ in form and course. This, in fact, is the basis of its classification. So, based on clinical manifestations, the following syndromes are distinguished:

Skin lesions of eosinophilic granulomatosis (Churg-Strauss syndrome)

1. Cutaneous- the most common variant that has nothing to do with thrombocytopenia, although outwardly quite similar to it;
2. Articular, as a rule, occurs in conjunction with the skin and is characterized by the involvement of various joints in the process, including large ones. In this case, there are migratory ("flying") pains, swelling in the joints and symmetry of the lesion;
3. Abdominal preceded by intestinal damage with possible bowel perforation and intestinal bleeding;
4. Renal, proceeding according to the scenario of acute glomerulonephritis, and in other cases giving nephrotic syndrome;
5. Mixed form HS (combination of several types).

Depending on the clinical course, the phase of activity and the severity of the disease, there are three types of hemorrhagic vasculitis:

• Light current:
• Moderate activity;
• Highly active process.

However, in the classification there is also such a factor as the onset of a pathological process associated with a further course. In such cases, we can talk about hemorrhagic vasculitis with:

1. Lightning-fast flow option;
2. Acute period;
3. Subacute current;
4. A protracted process;
5. Chronic recurrent form.

When studying vasculitis, the conclusion itself suggests itself that the prerequisite for the syndrome is an inadequate immune response of the body to some factor that impairs immunity. But HS that arise against the background of another pathology are not always of the same type, since they differ in the mechanism of formation of the pathological process. They have their own varieties, which can only be classified by specialists. We will only try to add a little information about vasculitis, which is of great interest to our readers. As a rule, these hemorrhagic syndromes are secondary, as they arise against the background and as a result of some kind of disease:

Clinical manifestations of forms and variants of the course of hepatitis B

The previously listed syndromes concerning skin rashes, gastrointestinal disorders, joint pain and renal pathology are considered basic signs in the diagnostic search for hemorrhagic vasculitis, and therefore they should be given a more detailed description.

For the most common and widely known - skin syndrome is characterized by the following manifestations:

1. The extensor surfaces of the upper and lower extremities (the lower third of the lower leg and the rear of the foot) are dotted with a symmetrical rash (papular-hemorrhagic) that spreads to the joints and the gluteal region (less often to the trunk). Sometimes blisters (urticarial elements) join the rashes, which is very similar to urticaria;
2. Absence (or appearance in very rare cases) of rashes on the abdomen, scalp, face, neck;
3. Hemorrhagic rash that does not disappear with pressure (unlike allergic) pink, red or deep red, which, in severe course, can merge, ulcerate, necrotize and subsequently leave noticeable pigmentation (doctors call it);
4. Angioedema affecting the hands, feet, almost the entire face and scalp, genitals, covering most of the body with painful infiltrates and "flying" edema, which can quickly disappear if you begin to intensively treat hepatitis B.

Cutaneous manifestations of hemorrhagic vasculitis

With a mild course, the patient's condition changes slightly, an increase in temperature is rarely observed (and even then not higher than subfebrile), rashes affect small areas of the body, there are no abnormalities from the gastrointestinal tract (abdominal syndrome).

Moderate activity is characterized by:

• The condition of a sick person, assessed as moderately severe;
• The presence of fever (38 ° C and above);
• The appearance of general weakness, pain in the head;
• The presence of painful sensations in the joints and their swelling;
• Abundant skin rashes, sometimes with the development of angioedema;
• The manifestation of abdominal syndrome: nausea, vomiting, diarrhea (sometimes with blood), excruciating abdominal pain;
• Peripheral blood reaction: leukocytosis exceeding 10x10 9 / l, neutrophilia with a shift to the left - 20-40 mm / h, accelerated coagulation according to Lee-White, violation of the ratio between protein fractions.

A high degree of activity gives a difficult clinical picture of the process and is expressed:

1. Headaches, weakness and malaise;
2. Significant disorders of the gastrointestinal tract (abdominal syndrome) with nausea, repeated bloody vomiting, frequent stools with blood;
3. Vivid symptoms of articular syndrome;
4. Cutaneous necrotic purpura, which has a confluent character;
5. The appearance in other cases of cardiovascular disorders;
6. Manifestations of kidney damage by the type of hematuric nephritis, as evidenced by the excess of the norm (over 5 Er in the field of view) the number of erythrocytes in the urine;
7. Significant changes in laboratory parameters.

In addition, hemorrhagic vasculitis may be accompanied by other clinical manifestations that are not mandatory, but sometimes present and give additional signs of hepatitis B, for example, vascular lesions of the heart and lungs, leading to pulmonary bleeding. Or symptoms characteristic of cerebral vasculitis with damage to the vessels of the brain:

• Headache;
• Delusional states;
• The appearance of convulsive and / or meningeal syndrome.

Obviously, it is not possible to isolate hemorrhagic vasculitis from other autoimmune diseases, accurately classify it and draw a single picture of clinical manifestations, since it has a strong connection with these processes and, like a syndrome, accompanies them.

Complications and consequences of hemorrhagic vasculitis

The severe form of the course with an acute onset, previously called fulminant and leading in most cases to death, fortunately, is very rare and is now quite successfully treated, but it often gives very serious complications and consequences in the form of:

1. Glomerulonephritis with further development of chronic renal failure, chronic renal failure;
2. Hemorrhage in the mesentery and;
3. Intussusceptions leading to intestinal obstruction;
4. Peritonitis resulting from necrosis of the intestine and its perforation;
5. Pulmonary bleeding.

It should be noted that these consequences can take place not only with a lightning-fast form, complications can give both protracted and chronic processes, and even a mild course, if the correct treatment is not started in time. And, if most complications can, in general, be dealt with, then severe kidney damage leads to irreversible consequences (development of chronic renal failure), when the patient's kidneys refuse to work and this function must be shifted to hemodialysis.

Diagnosis - hemorrhagic vasculitis

Examination of the patient with the identification of a rash, articular and other syndromes does not give grounds for asserting that hemorrhagic vasculitis was the cause of such phenomena, therefore laboratory tests are recognized as the main diagnostic methods, which include:

• General (detailed) blood test with the calculation of the absolute values ​​of indicators;
• Detection of circulating immune complexes (CIC);
• Determination of immunoglobulins of classes A (increased) and G (decreased), cryoglobulins and components of the complement system;
• Biochemical analysis (protein fractions,).

With hepatitis B, laboratory tests indicate the presence of circulating spontaneous aggregates, activation of the platelet link, a decrease in AT III, and inhibition of fibrinolysis. These factors ultimately cause severe hypercoagulation.

In addition to these studies, with hemorrhagic vasculitis, tests are performed that may indicate violations associated with hepatitis B (damage to the kidneys, intestines, heart, and other organs).

Treatment of hemorrhagic vasculitis

Mild manifestations of skin syndrome may require an outpatient (but bed!) Regimen with the obligatory adherence to a special diet (excluding meat, fish, eggs, obligate allergens, new foods) and the appointment of drug treatment.

However, the acute period requires a hospital stay, constant medical supervision, and in the case of the involvement of internal organs in the pathological process, the use of a large number of drugs prescribed according to special schemes and in certain dosages (corticosteroid hormones, heparin). In addition, it is preferable to administer drugs for HBs intravenously.

In the hospital, one way or another, you will have to follow a diet, because, in addition to the prescribed diet, they are unlikely to give what you want. The patient will be limited to the consumption of table salt and extractives, but fermented milk products (acidophilus, kefir), fruit drink and compote from local fruits (no exotic!), In which you can add literally a little sugar, will certainly be introduced. In case of problems with the intestines, the patient will receive table # 1, and with the kidneys - table # 7 (salt-free).

Bed rest will last for about a week after the last rash, so you should not refer to the absence of a rash, the doctor knows better. Yes, and the half-bed regime expands to free gradually, and not in one day.

If HS is diagnosed in a timely manner and did not have time to give complications, then it is recommended to treat it with non-steroidal anti-inflammatory drugs (NSAIDs), aminoquinoline and antihistamines, high doses of ascorbic acid with rutin, antiplatelet agents.

In severe form, hormone therapy is provided, and in case of lightning-fast - intensive plasmapheresis. The fact that the tactics of treatment have been chosen correctly will be evidenced by a feeling of recovery due to the disappearance of the rash. Simultaneously with the treatment of hepatitis B, active rehabilitation and elimination of foci of chronic infection are started right in the hospital.

After the patient is discharged, rehabilitation, dispensary observation and prevention of relapses at home await.

Video: treatment of vasculitis

How to prevent exacerbations?

After being discharged from the hospital, the patient should not forget about his illness at home.... Of course, by that time he had already learned everything about the nature of the disease, prevention of exacerbations, behavior in everyday life, nutrition and daily routine. Having plunged into the home atmosphere, the patient will not take any medications without a doctor's prescription, will not pounce on foods that can provoke a relapse (allergens), but at the same time he will eat fully and every evening he will take calm light walks in the fresh air. In addition, the person contraindicated:

1. Heavy physical labor (children are exempt from physical education lessons);
2. Hypothermia;
3. Excessive excitement, mental stress;
4. Vaccinations (possible only for health reasons);
5. The introduction of immunoglobulins (antistaphylococcal, tetanus, etc.).

One should not miss the moment that it is necessary to prevent the exacerbation of chronic infections, but at the same time, antibiotics and other allergens should be abandoned.

Due to the fact that hemorrhagic vasculitis is predominantly a childhood disease, there are special recommendations for kids (or parents?):

• Dispensary observation for at least 5 years if the kidneys remain healthy, but if they are damaged, control may be lifelong;
• Every six months, the child visits the attending physician (in the absence of exacerbations);
• 3 times a year, there is a mandatory visit to the dentist and otolaryngologist;
• Children are completely exempt from physical exercises for a year, then go to the preparatory group;
• Vaccinations are excluded for 2 years, and after this time, routine vaccination is carried out, but with the permission of the attending physician and under "antihistamine cover";
• Regular urine tests (general and according to Nechiporenko) and feces analysis for helminths;
• Compliance with an anti-allergenic diet - 2 years;
• Advice to parents or other relatives on home treatment, relapse prevention, nutrition and behavior at school and at home.

Many people with hepatitis B are actively interested in the treatment of the disease with folk remedies. Herbalists offer many recipes for making herbal infusions. Recommendations on how and what to do can be found in abundance on the Internet, however, taking into account the variety of forms, types and reasons that prompted the hemorrhagic syndrome, it is better to coordinate these actions with the attending physician. In order not to harm.