Dermatology - Atherosclerosis

Dermatology - Atherosclerosis
Atherosclerosis, a condition characterized by the buildup of plaque in the arteries, is linked to a range of skin manifestations. It affects 5% of males who are over 50 years old, and 10% of those individuals go on to suffer critical limb ischemia. The risk factors include hyperlipidemia, hypercholesterolemia, cigarette smoking, hypertension, diabetes, hyperinsulinemia, abdominal obesity, a familial history of early ischemic heart disease, and a personal history of cerebrovascular or occlusive peripheral vascular illness.

The symptoms vary from exercise-induced discomfort to paresthesias occurring at rest in the leg and/or foot, particularly during nighttime. Large vessel pulses are typically reduced or nonexistent. Gangrene may develop in diabetics with microangiopathy, even when pulses are present. The temperature of the foot ranges from cool to frigid. When there is a notable decrease in the flow of blood through the arteries, raising the limb creates a paleness in the skin (most noticeable on the sole of the foot; known as Bürger sign).Dependency results in the delayed and intensified increase in blood flow to a specific area.Auscultation of stenotic arteries detects bruits.A lesion.The diseased limb exhibits pallor, cyanosis, a livedoid vascular pattern, and alopecia.Early infarctive alterations manifest as distinct, clearly defined regions of epidermal cell death resembling a map.. Subsequently, the infarcted skin may undergo dry black gangrene, characterized by a progression from purple cyanosis to white pallor and ultimately to black gangrene.The shedding of slough results in the formation of distinct ulcers, exposing underlying tissues such as tendons.ischemia ulcers can cause significant pain. However, in individuals with diabetes and neuropathy who also have ischemia ulcers, the level of discomfort experienced may be reduced or completely absent.The user's text is empty.

The diagnosis is based on clinical evaluation and validated with arteriography. The differential diagnosis for this condition includes pseudoxanthoma elasticum, Bürger disease (thromboangiitis obliterans), arthritis, gout, interdigital neuroma, calcanean bursitis, plantar fasciitis, rupture of plantar muscle, vasculitis, Raynaud phenomenon, disseminated intravascular coagulation, cryoglobulinemia, macroglobulinemia, septic embolization (infective endocarditis), nonseptic embolization, drug-induced necrosis (warfarin, heparin), ergot poisoning, intraarterial injection, livedo reticularis syndromes, and popliteal entrapment.The user's text is empty.

Manage hyperlipidemia by the use of statins, dietary modifications, and physical activity, or by lowering raised blood pressure.
Patients should be assisted in quitting smoking and motivated to engage in regular walking to promote the development of new collateral blood vessels and position the ischemic foot at the lowest possible level without swelling. Administer heparin, warfarin, intravenous prostacyclins, and analgesics to alleviate symptoms.
Surgical intervention such as endarterectomy or bypass is recommended for iliac occlusions, and any necrotic tissue should be removed through debridement.