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Dermatology
Cutaneous Manifestations of Microvascular Occlusion Syndromes
Built from Dermatology, 5th Edition
What’s inside
11 sections · 124 slides
Overview
- What this topic covers
- “
Recognizing Microvascular Occlusion
The clinical clue (retiform purpura), why the distinction matters, and a screening workup
- Retiform purpura: the key visual clue
- Why occlusion versus vasculitis matters
- Algorithm for evaluating retiform purpura
- Microvascular occlusion grouped by mechanism
- Microvascular occlusion grouped by mechanism (continued)
- Building a basic laboratory workup
- Basic screening tests for occlusive syndromes
Platelet-Related Thrombopathy
Heparin-induced thrombocytopenia, myeloproliferative neoplasms, PNH, and thrombotic microangiopathy
- Heparin-induced thrombocytopenia (HIT) syndrome
- How HIT causes clotting
- HIT: who is at risk, and when it strikes
- What HIT skin lesions look like
- Diagnosing HIT
- Treating HIT
- Myeloproliferative neoplasms (MPNs)
- The three Philadelphia chromosome-negative MPNs
- Erythromelalgia: a platelet-driven clue
- MPNs: diagnosis and treatment
- Paroxysmal nocturnal hemoglobinuria (PNH)
- PNH: skin findings and treatment
- Primary thrombotic microangiopathy (TMA)
- The three primary thrombotic microangiopathies
- TTP pathogenesis
- Working through a thrombotic microangiopathy
- TMA: how to tell it apart from DIC
- Treating primary TMA
Cold-Triggered Protein Occlusion
Cryoglobulins, cryofibrinogens, and cold agglutinins - proteins that clot or clump in the cold
- Three cold-sensitive blood proteins
- Cryoglobulins: two disease mechanisms
- Type I cryoglobulinemia: clinical picture
- Thrombotic vasculopathy in type I cryoglobulinemia
- Cryofibrinogenemia
- Cold agglutinin disease
- Cold agglutinin disease - histopathology
- Treating cold-triggered occlusion
Occlusion by Organisms Inside Vessels
Ecthyma gangrenosum, angioinvasive fungi, strongyloidiasis, Lucio phenomenon, and rickettsial infection
- A shared pattern: organisms growing inside vessel walls
- Ecthyma gangrenosum
- Angioinvasive fungi
- Disseminated strongyloidiasis and Lucio phenomenon
- Rocky Mountain spotted fever
- Treating vessel-invasive organism infections
Occlusion by Emboli
Cholesterol and oxalate emboli, plus rarer sources: myxoma, endocarditis, crystalglobulins, hypereosinophilia
- Cholesterol embolus: who gets it
- What triggers a cholesterol embolus shower
- Cholesterol emboli: skin findings and histology
- Cholesterol embolus: the full clinical picture
- Cholesterol embolus: pathology and treatment
- Oxalate embolus
- Other embolus-associated syndromes
- Cutaneous embolism from an atrial myxoma - histopathology
Purpura Fulminans, Warfarin Necrosis, and APS
Protein C and S failure states, and the antiphospholipid antibody syndrome
- Purpura fulminans: a shared final pathway
- Neonatal purpura fulminans
- Warfarin necrosis: why it happens
- Warfarin necrosis: clinical picture
- Warfarin-associated venous limb gangrene
- Purpura fulminans with sepsis
- Purpura fulminans after infection
- Antiphospholipid antibody syndrome (APS): the basics
- 0.3-1%
- APS: cutaneous findings
- Antiphospholipid antibody syndrome: Sapporo-Sydney criteria
- Cutaneous findings reported in APS
- Cutaneous findings reported in APS (continued)
- Catastrophic APS (CAPS)
- APS: pathology, testing, and treatment
Sneddon Syndrome, Livedoid Vasculopathy, and Degos Disease
Vascular coagulopathies with distinctive skin patterns and named eponyms
- Sneddon syndrome: the core picture
- What drives Sneddon syndrome
- Sneddon syndrome: the neurologic course
- ADA2 deficiency: a pediatric Sneddon mimic
- Sneddon syndrome and its cutaneous/neural mimics
- Sneddon syndrome: pathology and treatment
- Livedoid vasculopathy: the core picture
- Livedoid vasculopathy: what drives it
- Livedoid vasculopathy: clinical features
- Livedoid vasculopathy: pathology
- Disorders that may mimic livedoid vasculopathy
- Disorders that may mimic livedoid vasculopathy (continued)
- IgA vasculitis mimicking livedoid vasculopathy
- Livedoid vasculopathy: treatment
- Drug-triggered vascular ulcers
- Benign and malignant atrophic papulosis (Degos disease)
- Two forms of atrophic papulosis
- Degos disease: clinical features
- Degos disease: pathology and treatment
- Levamisole-adulterated cocaine vasculopathy
- Levamisole vasculopathy: pathology and treatment
- Calciphylaxis: the vascular mechanism
Cell-Related Vascular Occlusion
Sickle cell disease, thalassemia, and clotting driven by circulating malignant cells
- Sickle cell disease: how vessels get blocked
- Sickle cell disease: leg ulcers and treatment
- Thalassemia and other hemolytic anemias
- Intravascular cellular occlusion
- Intravascular B cell lymphoma
- Cutaneous intralymphatic histiocytosis
Miscellaneous Occlusion Syndromes
Spider bites, hematoma compression, and the vascular face of COVID-19 and vaccine reactions
- Loxosceles spider bites and hematoma compression
- SARS-CoV-2 and the skin: the underlying idea
- Pernio-like disease ("COVID toes")
- Retiform thrombotic purpura in critical COVID-19
- COVID-19-associated coagulopathy
- Vaccine-induced immune thrombotic thrombocytopenia (VITT)
- VITT: clinical features
- Gallery: histopathology of cutaneous emboli, thrombi, and vasculopathies
Summary
The clinical thread that ties every entity in this topic together
- The clinical thread that ties this all together
- Where new understanding is heading
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- Dermatology, 5th Edition (2-Volume Set)