Hemorrhagic rashes: symptoms, causes and treatment
The rash is one of the first symptoms of developing disease - is a modification of the skin. Hemorrhagic vasculitis - a disease that affects the skin capillaries, serous membranes of the lungs and heart, cerebral vascular, joints, gastrointestinal tract, liver, kidneys.
Onset of the disease is accompanied by the appearance of the characteristic skin eruption is shown by fine spotty, star-shaped spots of purple color, not changing its color when pressed. Rash caused by injuries to the walls of fragile capillaries. The little spots are called "petechiae", "purple".
It is very important at the first sign of a rash to do a blood test to rule out the suspicions, and if there are skin lesions of unknown origin.
The symptoms of the disease
The first symptoms of the disease causing such serious complications - minor bruising-bleeding, does not disappear after pressing. Hemorrhagic diathesis is localized on the extensor surfaces of arms and legs, on the buttocks, in the joints, sometimes on the face or all over the body, on the skin of the palms and feet.
This files most often diagnosed hemorrhagic rash on the legs, which significantly complicates the diagnosis, as these symptoms occur when different diseases. The intensity of the rash is both single and a multiple nature.
After the disappearance of bruises can be residual effects in the form of pigmentation and peeling.
The second factor is damage to the joints is observed in 2/3 patients in the first week of the disease. Some patients experience occasional pain in other inflammation. Most often damaged large joints (knee, ankle).
Third signal - sudden sharp abdominal pain, possible diarrhea, nausea and vomiting, high temperature. Vomiting is the color of blood, the stool black. In rare cases, observed the intestinal and stomach bleeding. May damage kidneys and other organs.
Hemorrhagic rash - an autoimmune disease of unknown etiology. Cells of the immune system, for unknown reason, suddenly begin to perceive their own blood vascular as foreign, producing antibodies, which literally eat them.
Most often an increased permeability of the vascular, when the blood overcomes the subcutaneous tissue, causing petechial rash, diagnosed in a child older than 3 years, mainly males, however, can develop at any age.
The reasons for the development of the disease
To hemorrhagic diateza are three groups of diseases:
- Violation of the production factors that affect clottingblood (cause heavy bleeding).
- The decrease in the number of cells (platelets), responsible for the formation of clots in the affected location.
- Inflammation of small and medium-sized vascular, causing breakage.
Called other causes of hemorrhagic rash, in particular, provoke the development of disease infection, the most dangerous of them:
- Meningococcal virus - solid rash is star-shaped with necrotic tissue. Hemorrhagic rash on the face is a symptom of a life-threatening disease.
- Scarlet fever - point bruises when pressed.
- The tick bites can cause hemorrhagic fever, accompanied by profuse rash.
A role played by heredity, treatment with steroid means impaired blood flow. Among the reasons for the development of the disease called age-related changes.
Hemorrhagic rash in children under five years of age may indicate serious diseases of the microvasculature. At risk patients 4-12 years old, ill with scarlet fever, sore throat, respiratory catarrh, after a trauma, vaccinations, or hypothermia, and also prone to diateza.
If rash, joint pain and indigestion should go to a rheumatologist. The treatment is carried out in stationary conditions, forecasts favorable. This disease requires compliance with bed rest.
Treatment of hemorrhagic vasculitis
Vascular inflammation is removed the two groups of drugs: in mild forms is a non - steroidal remedies for the symptomatic treatment, in severe corticosteroid groups, reducing the production of factors that synthesizing cells to vascular injury.
If hormonal drugs are ineffective, applying cytotoxic means kills immune cells (typically used in the treatment of malignant tumors).
It is important to understand that corticosteroids do not cure the vasculitis, but only to protect organs from the damaging effects of aggressive immune cells. This is not an excavator, eradicating evil, and the only umbrella that protects against hemorrhagic vasculitis.
To cure vasculitis impossible, but to prevent damage to vascular and organs is necessary. When I prescribe, and when you can do the prevention? Treatment is recommended for active inflammation of the blood vascular. If no inflammation (in remission) therapy is useless.
For example, a month ago, the patient observed edema, impaired renal function (according to tests) on legs rash punctulate. The diagnosis of hemorrhagic vasculitis affecting kidneys and skin.Stabilized independently before the start of treatment. This temporary improvement is called remission.
In this case, the treatment is meaningless, as authorities can't protect from what. The patient is recommended just an observation.
Treatment is prescribed when the active symptoms of the hemorrhagic rash. If the signs of vasculitis are minor and internal organs are not hurt, you can just watch for changes. In all other cases, the disease treated in its active stage.
The vasculitis are acute, remitting, partial and even complete remission. In the latter case, treatment is not required, just observation.
There are three types of treatment:
- induction of remission;
- maintenance of remission;
- temporary withdrawal of drugs.
Induction is when a steroid or cytostatic in any combination is administered in relatively large doses. The dose is selected so that cessation of all clinical and laboratory manifestations of vasculitis. Then the dose of drugs gradually reduced to the minimum, able to keep the patient in remission.
If medicated remission continues for a few months, you can try to undo the drugs.
You have to understand that drug and non-drug remission is temporary: at any moment there may be fever, in which without delay is necessary to return to the mode of induction of remission. In this transition, the important role of the patient as it is necessary to determine the signs by which you can recognize the aggravation.
Talk to your doctor-a rheumatologist, to his, because vasculitis is a relatively rare disease and not every doctor can choose the correct treatment regimen. In such a situation, you can increase the dose of conventional medication and immediately contact your doctor.
On the advice doctors give recommendations, but not always the patient adequately understands the information.
In preparation for the meeting with the doctor have to make a list of questions and prepare answers to them:
- How can I identify a fever?
- In what situations I need to immediately consult the doctor?
- In any case, I can increase your meds?
Knowing the answers to these questions will allow you to feel comfortable, while maintaining the ability to work despite chronic illness. Use of corticosteroids and cytotoxic drugs is accompanied by side effects. They need to know, track, and inform your doctor.
In addition to corticosteroids and zitostatikam developed and other therapeutic treatments
- Pulse therapy - short course of large intravenous doses of corticosteroids. Used in situations when you need to quickly remove the inflammation.
- Plasmapheresis is an extracorporeal procedure, the fence, cleaning the blood and returning part thereof, free from antibodies in the bloodstream. Looks like? A method of separating blood outside the body removes the liquid part of with toxic compounds, returning the cells to the patient.
- Together with the plasma removed immune complexes, autoantibodies, substances that cause inflammation. Plasmapheresis has a strong, though temporary therapeutic effect. Applied in a situation with vasculitis that is resistant to treatment by other methods or in emergency situations. This is a very effective method, but treatment with steroids and cytostatic agents it does not replace.
- Rituximab - a chimeric antibody against b-lymphocytes. The drug at the time of destroys the cells that produce antibodies. The tool also suppresses the immune system, but such side effects as steroids and cytotoxic drugs has not. It's an expensive drug, and for maintenance treatment it is not used.
- Since vasculitis affects the organs, then apply specific drugs for the treatment of the patient's body - kidneys, lungs, blood vascular of the brain.
Some vasculitis can be cured, if you remove the root cause of their appearance.
For example, if a hemorrhagic diathesis caused by the use of some medications (mostly antibiotics), it can simply be replaced. If vasculitis caused by hepatitis C virus, the flu or another infection, is assigned antiviral therapy against the causative infection.
If a hemorrhagic diathesis is a food Allergy, it is necessary to abandon certain types of products.
Side effects of drugs in the treatment of vasculitis
Most often in the treatment of hemorrhagic rash prescribe corticosteroid drugs such as prednisone, and patients have to deal with their side effects.
Steroid drugs are the synthetic analogs of the adrenal hormone cortisol, and the treatment gives them all the symptoms characteristic of its high level. The hormone interferes with the metabolism and affect all body organs.
- Mood swings, insomnia observed in 10% of patients. Usually pass with time without any additional treatment.
- Steroids contribute to the increase of acidity is aggravated gastritis and even ulcers. Steroid ulcer may be asymptomatic until stomach bleeding. For the prevention prescribe a means of reducing the acidity of gastric juice.
- Corticosteroids do not affect the pressure, but in hypertensive patients theycan make it even higher. Such patients need to constantly monitor the pressure. If necessary, the doctor will review the treatment of hypertension.
- If the blood sugar is elevated, then the treatment with steroids, he could jump even higher. When such symptoms (dry mouth, thirst, frequent urination) urgently needs to see a doctor. Need to purchase blood glucose meter.
- The increase in body weight. Steroids contribute to the accumulation of fat on the abdomen, neck, chest and face. Recommended low-calorie diet. Part of steroid drugs, the doctor can replace with cytostatics.
- Osteoporosis - loss of calcium from bones. With prolonged use, bones become brittle, may fracture. For prevention of osteoporosis prescribers calcium and vitamin D, but their effectiveness is not enough.
- Swelling and fluid retention due to potassium loss and delay of sodium. Prescribe salt-free diet, diuretics.
Cytostatics are drugs that affect DNA, the suppression effect of the cells. Immune cells divide very rapidly, the use of cytotoxic drugs exerts beneficial effects in autoimmune diseases. Vasculitis is used as a hard cytostatics (cyclophosphamide) and softer (methotrexate). The same drugs used in Oncology to suppress cancer cells.
In the treatment with cytostatics affects primarily rapidly dividing cells, for example, the epithelium - the skin , the mucous membrane of the nose and the mouth, esophagus, stomach, intestines, respiratory system etc.
If the epithelium is not updated, you may experience redness, pustules, peeling, hair loss. Appear on mucous inflammation, erosion, pharyngitis, nausea, vomiting, impaired digestion. With the genitourinary system are irritation and inflammation of the bladder with frequent urination in the toilet.
Rarely observed in the kidneys and blood in the urine. But the most dangerous complication from the use of cytotoxic drugs - changes in bone marrow that produce erythrocytes, leukocytes and platelets. Cytotoxic agents can inhibit the production of any of them, so you need to regularly donate blood.
Reduced and sperm production, therefore, during treatment planning of pregnancy is prohibited.
Pregnant cytotoxic agents cause slower development of the fetus. Before starting treatment the woman should be screened for pregnancy.
About side effects patients know and at the first opportunity refuse harmful drugs, agreeing to tolerate the disease. But prolonged inflammation results in irreversible changes in the internal organs.
This situation can lead todisability and the need for transplantation of the damaged organ. Therefore, it is important to know side effects of medication and learn to live with them.
The role of the patient in the treatment of this disease is no less important than the role of a doctor. After all, he was the only person watching his illness around the clock.
Therefore, it is important that the patient was informed about his illness and knew in which cases he must immediately seek medical attention from your doctor, and when you can increase the dose of medication.