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                             Veins and Lymphatics 2016; volume 5:5981

[page 4]                                                            [Veins and Lymphatics 2016; 5:5981]

Compression in vasculitis
Valentina Dini
Department of Dermatology, University
of Pisa, Italy

Cutaneous vasculitis is a pathological
process characterized by inflammation of the
skin blood vessel wall leading to an alteration
of the blood flow, ischemia and tissue damage.
The most important histopathologic feature is
an inflammatory cell infiltration with fibrinoid
necrosis and destruction of blood vessels. The
heterogeneous group of vasculitic disorders
has been classified not only by primary and
secondary causes but also by the size of the
affected vessel. The diagnosis is based on clin-
ical features and tissue and laboratory evalua-
tion.
Vasculitis affecting small vessels is the most

common type in dermatology, also known with
the histologic term of leukocytoclastic vasculitis.
The distribution of skin lesions often starts

on dependent areas (e.g., feet, lower legs, but-
tocks) before becoming generalized. This is
due to the effect of hydrostatic forces on the
post capillary venules leading to the preferen-
tial deposition of immune complexes at these
sites. The major cutaneous manifestation is
represented by a palpable purpura. The evolu-
tion of skin lesions depends on the etiology
and can be acute resolving, within several days
to weeks, or chronic persisting, from months
to years. The clinical presentation is character-
ized by increasing crops, evolving from palpa-
ble purpura to papules and nodules, leading to
a significant post-inflammatory hyperpigmen-
tation. The lesions are commonly palpable and

non-blanching, often demonstrated by applying
pressure with a glass tumbler. Purpura is due
to extravasation of red blood cells and can be
associated with vesicles, bullae and ulcers.
Small vessels vasculitis are idiophatic in the

50% of the cases or associated with drugs,
infections, in particular hepatitis, Wegener’s
granulomatosis, Churg Strauss syndrome and
Henoch-Schonlein purpura. The major patho-
genetic mechanism is an immune complex
reaction with a leukocytoclastic vasculitis with
predominantly neutrophilic infiltrate.
The treatment depends on the cause of the

cutaneous vasculitis. If the underlying pathol-
ogy is a primary vasculitis, treatment is based
on the disease severity and systemic involve-
ment. If the vasculitis involves only the skin,
conservative measures can be undertaken.
They include corticosteroids and immunosup-
pressive drugs while, when associated, skin
ulcer local treatment can include moist wound
dressings and bandaging. In addition, patients
can receive basic instructions on self-care,
including recommendations about diminish
the factors known to exacerbate vasculitis
such as excessive standing, cold exposure,
wearing tight-fitting cloths, and promote rest
as the legs elevated.
Compression by bandages has not yet shown

to be useful in vasculitic skin lesions, so far.
In the Department of Dermatology of the

University of Pisa we have treated 31 patients
(female:male = 3:1) in the age range between
26-65 years. The eco color Doppler did not
show significant findings in 28 patients and
was positive for venous insufficiency in 3
patients. 15 patients were affected by small or
medium vessels vasculitis, 3 by rheumatoid
arthritis, 2 by Churg Strauss syndrome, 4 by

cryoglobulinaemia, 1 by Sjögren syndrome and
Behçet disease and 1 by necrotizing vasculitis.
We have evaluated the patients attending

our clinic together with the rheumatologists.
During the first clinical manifestation of skin
lesions we started systemic drug and compres-
sive short stretch bandaging. In case of relapse
we applied compression by bandages before
increasing the dose of systemic therapy or
switching to a new drug. Only in a few cases
we applied an ultraportable negative pressure
therapy.
In our experience compression therapy by

short stretch bandages in vasculitic ulcers with
or without venous insufficiency, was very use-
ful in order to improve the healing time,
relieve the burning sensation and pain, due to
the reduction of inflammation of blood vessels. 
In our opinion the compression therapy can

be used in the inflammatory phase of vasculi-
tis with or without leg ulcers in order to reduce
the administration of systemic steroids.

Correspondence: Valentina Dini, Department of
Dermatology, University of Pisa, via Savi 10
56126 Pisa, Italy.
E-mail: valentina.dini@unipi.it

This work is licensed under a Creative Commons
Attribution 4.0 License (by-nc 4.0).

©Copyright V. Dini, 2016
Licensee PAGEPress, Italy
Veins and Lymphatics 2016; 5:5981
doi:10.4081/vl.2016.5981