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Vascular and lymphatic diseases
Blood vessel disorders
Erythema
Erythema is redness of the skin, usually due to vasodilatation ( Table 40.1 ). It may be localized, e.g. with pregnancy or liver disease (on palms), fixed drug eruption and infection (e.g. Lyme disease), or generalized, as with drug eruption, toxic erythema (e.g. viral exanthem) and connective tissue disease.
Table 40.1
Classification of blood vessel and lymphatic disorders
| Vessel | Process | Resulting lesion |
|---|---|---|
| Small blood vessels | Dilatation (and/or increased flow) | Erythema, flushing, telangiectasia |
| Release of extracellular fluid | Urticaria (p. 94), oedema | |
| Release of blood | Purpura, capillaritis | |
| Reduced flow | Livedo reticularis, chilblains, Raynaud’s phenomenon | |
| Inflammation damage | Vasculitis, erythema ab igne | |
| Arteries | Atherosclerosis, Buerger’s disease | Ischaemia and ulceration |
| Inflammation | Vasculitis (p. 102) | |
| Veins | Inflammation, flow reduction, clotting abnormalities | Thrombosis, skin changes, ulceration (p. 90) |
| Dilatation | Venous lake | |
| Lymphatics | Congenital hypoplasia | Lymphoedema (primary) |
| Blockage or inflammation | Lymphoedema (secondary) | |
| Infection | Lymphangitis |
Flushing
Flushing is erythema due to vasodilatation. The causes are:
- ●
physiological (autonomic response to emotion, heat or exercise)
- ●
menopausal (hormonal; often with associated sweating)
- ●
foods (e.g. spices—gustatory; alcohol—aldehyde-related)
- ●
drugs (angiotensin-converting enzyme [ACE] inhibitors, 5-hydroxytryptamine [5-HT 3 ] antagonists, nifedipine)
- ●
rosacea (mechanism unknown)
- ●
carcinoid syndrome (serotonin—5-HT)
- ●
phaeochromocytoma (catecholamine).
Flushing is common and affects the face, neck and upper trunk. It is usually benign. A sudden onset and systemic symptoms (e.g. diarrhoea or fainting) mean that carcinoid syndrome or phaeochromocytoma must be excluded. In treatment, first remove the cause, e.g. spices or alcohol. Embarrassing physiological flushing may improve with a small dose of propranolol.
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