Polyarteritis nodosa (PAN) is a necrotizing vasculitis that involves small or medium-sized arterioles. Classic PAN is characterized by fever, weight loss, cutaneous ulcers, livedo reticularis, myalgias and weekness, arthralgias or arthritis, neuropathy, abdominal pain, ischemic bowel, testicular pain, hypertension, & renal failure. Microscopic polyarteritis (MPA) involves the same sized vesels as well as smaller vessels, and is menifest clinically as a glomerulonephritis and a pulmonary capillaritis with alveolar hermarrhage. Patients with MPA may develop small vessel vasculitis ( palpble purpura), livedo reticularis with or without nodules, and/or ulcreations of the skin. Cutaneous PAN, sometimes termed benign cutaneous polyarteritis, is characterized by livedo reticularis, nodules and ulceration, usually of the leg; it has been postulated to be a localized necrotizing arteritis that does not affect internal organs, and runs a chronic but benign course. Many reports, however, have linked cPAN to inflammatory bowel disease, or hepatitis B or C infection. Occasional reports have linked cPAN to antiphospholipid antibodies, cryoproteins, or antineutrophil cytoplasmic antibodies. Some cases have occurred in patients treated with propylthiouracil and minocycline (cPAN appears to be more prevalent in children ). Although it is generally benign, there have been reports of associated neuropathy, as well as visceral involvement. Dermatologist in Delhi and Hair treatment in Delhi treats it effectively.
Specific Investigations
- Skin biopsy
- Serology for hepatitis B and C, antineutrophil cytoplasmic antibody, antiphospholipid antibodies, and cryoproteins
- Assessment for systemic involvement
- Assessment for inflammatory bowel disease
- Assessment for drugs that have been linked to cPAN
Therapies
- Local measures – support stocking, local wound care
- Systemic corticosteroids
- Immunosuppressants – azathioprine, methotrexate