Inflammatory Skin Diseases and Wounds

Joachim Dissemond; Marco Romanelli

Disclosures

The British Journal of Dermatology. 2022;187(2):167-177. 

In This Article

Abstract and Introduction

Abstract

Inflammatory wounds of the skin can be caused by many different diseases. Of particular importance here are the very heterogeneous groups of vasculitides and vasculopathies. These are usually interdisciplinary relevant diseases that require extensive diagnostics in specialized centres. Clinically, these inflammatory wounds present as very painful ulcers that develop from necrosis and are surrounded by erythematous livid borders. The healing process is often difficult and protracted. Moreover, it considerably impairs the quality of life of the affected patients. In addition to clinical evaluation, histopathological examination of biopsies taken as early as possible is particularly important in diagnosis. Numerous differential diagnoses must be ruled out. Therapeutically, in addition to the often necessary systemic therapies, which include immunosuppressants (immunomodulating drugs and/or rheologics), appropriate topical wound treatment, usually in combination with compression therapy, should always be considered. Whenever possible, the causative factors should be diagnosed early and avoided or treated.

Introduction

Nonhealing wounds are a multidisciplinary challenge and not only result in high costs, but also significantly affect the psychosocial wellbeing of patients and their quality of life.[1] The most common underlying causes of chronic wounds are diabetes mellitus, chronic venous insufficiency, peripheral arterial occlusive disease and pressure injury.[2] Much rarer causes of ulcerations are inflammatory skin diseases. Inflammation describes a complex endogenous response to potentially damaging stimuli. The five classic signs of inflammation are heat, pain, redness, swelling and loss of function. These are an important component of physiological homeostasis. However, if uncontrolled or excessive, inflammation can cause damage and disease. In acute inflammation, resident immune cells such as macrophages, histiocytes and mast cells, which release numerous inflammatory mediators, are pathophysiologically important. In addition, the complement, coagulation and fibrinolysis systems are activated. It is essential to distinguish between inflammation and infection in wounds that are not healing. A recently validated Therapeutic Index for Local Infections (TILI) score can be an easy-to-use diagnostic tool in clinical practice to identify local wound infections (Table 1).[3] There are many different types of inflammatory wounds. The two major causative groups of diseases that need to be differentiated are vasculitides and vasculopathies (Table 2). Vasculitides are primary inflammatory vascular diseases in which the immune system attacks the blood vessels. In contrast, vasculopathies are primarily noninflammatory vascular diseases of various causes that lead to a partial or complete occlusion of the vessels. Even though clinically there are very similar-looking wounds, the resulting approaches are fundamentally different.

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