PMC10267297_01
Comparison of cutaneous PAN ulcers/skin lesions before and after treatment with tofacitinib. (A, B) Patient 1: Livedo racemosa on both lower limbs (pre-ulcerative stage; A) and healed cutaneous lesion after 12 weeks of tofacitinib treatment (B). (C, D) Patient 2: purpuric lesions on bilateral lower extremities, with pedal oedema (C) and rapid regression of ulcers with scarring after tofacitinib therapy (D). (E, F) Patient 3: left lateral malleolar non-healing superficial ulcer (E) and healed cutaneous ulcers after tofacitinib therapy (F). (G, H) Patient 4: multiple non-healing ulcers on the foot (G) and ulcers healed with fibrosis after tofacitinib therapy (H)
rkad049f1.jpg
PMC10267297_04_rkad049f1.jpg
rkad049-F1
A 32-year-old female patient presented with multiple pruritic purpuric rashes and non-healing ulcers on the foot (Fig. 1G). The ulcers healed with fibrosis and scarring [Fig. 1H].
PMC10267297_02
Comparison of cutaneous PAN ulcers/skin lesions before and after treatment with tofacitinib. (A, B) Patient 1: Livedo racemosa on both lower limbs (pre-ulcerative stage; A) and healed cutaneous lesion after 12 weeks of tofacitinib treatment (B). (C, D) Patient 2: purpuric lesions on bilateral lower extremities, with pedal oedema (C) and rapid regression of ulcers with scarring after tofacitinib therapy (D). (E, F) Patient 3: left lateral malleolar non-healing superficial ulcer (E) and healed cutaneous ulcers after tofacitinib therapy (F). (G, H) Patient 4: multiple non-healing ulcers on the foot (G) and ulcers healed with fibrosis after tofacitinib therapy (H)
rkad049f1.jpg
PMC10267297_04_rkad049f1.jpg
rkad049-F1
A 32-year-old female patient presented with multiple pruritic purpuric rashes and non-healing ulcers on the foot (Fig. 1G). The ulcers healed with fibrosis and scarring [Fig. 1H].
Skin biopsy findings of patients with cutaneous PAN. (A) Patient 2: small vessels in upper and mid dermis show fibrinoid necrosis and are surrounded and infiltrated by inflammatory cells, including neutrophils, lymphocytes, eosinophils with karyorrhectic debris. Leucocytoclastic vasculitis: skin biopsy from right leg. (B) Patient 3: the wall of the artery (arrow) shows a circumferential bright pink area of necrosis with protein deposition and inflammation (dark nuclei of neutrophil), i.e. fibrinoid necrosis. Patient 1 (not shown in figure): according to biopsy report, the dermis shows vessels with fibrinoid material deposition in the vessel wall and vessel lumen. The inflammatory infiltrate comprises a few lymphocytes and histiocytes. Features are suggestive of leucocytoclastic vasculitis. Patient 4 (not shown in figure): according to biopsy report, the epidermis shows papillomatosis, and hyperkeratosis with follicular plugging. The dermis shows perivascular lymphocytic infiltrate with fibrinoid necrosis of vessel wall involving medium-sized vessels, some of which are seen in the deepest dermis. Leucocytolysis is also seen. Biopsy skin from the leg shows necrotizing leucocytoclastic vasculitis involving medium-sized blood vessels
rkad049f2.jpg
PMC10267297_03_rkad049f2.jpg
rkad049-F2
Ulcer biopsy revealed fibrinoid necrosis in upper dermal vessels, with proliferating blood vessels lined by plump endothelial cells (Fig. 2B).
PMC10267297_03
Comparison of cutaneous PAN ulcers/skin lesions before and after treatment with tofacitinib. (A, B) Patient 1: Livedo racemosa on both lower limbs (pre-ulcerative stage; A) and healed cutaneous lesion after 12 weeks of tofacitinib treatment (B). (C, D) Patient 2: purpuric lesions on bilateral lower extremities, with pedal oedema (C) and rapid regression of ulcers with scarring after tofacitinib therapy (D). (E, F) Patient 3: left lateral malleolar non-healing superficial ulcer (E) and healed cutaneous ulcers after tofacitinib therapy (F). (G, H) Patient 4: multiple non-healing ulcers on the foot (G) and ulcers healed with fibrosis after tofacitinib therapy (H)
rkad049f1.jpg
PMC10267297_04_rkad049f1.jpg
rkad049-F1
A 32-year-old female patient presented with multiple pruritic purpuric rashes and non-healing ulcers on the foot (Fig. 1G). The ulcers healed with fibrosis and scarring [Fig. 1H].
Skin biopsy findings of patients with cutaneous PAN. (A) Patient 2: small vessels in upper and mid dermis show fibrinoid necrosis and are surrounded and infiltrated by inflammatory cells, including neutrophils, lymphocytes, eosinophils with karyorrhectic debris. Leucocytoclastic vasculitis: skin biopsy from right leg. (B) Patient 3: the wall of the artery (arrow) shows a circumferential bright pink area of necrosis with protein deposition and inflammation (dark nuclei of neutrophil), i.e. fibrinoid necrosis. Patient 1 (not shown in figure): according to biopsy report, the dermis shows vessels with fibrinoid material deposition in the vessel wall and vessel lumen. The inflammatory infiltrate comprises a few lymphocytes and histiocytes. Features are suggestive of leucocytoclastic vasculitis. Patient 4 (not shown in figure): according to biopsy report, the epidermis shows papillomatosis, and hyperkeratosis with follicular plugging. The dermis shows perivascular lymphocytic infiltrate with fibrinoid necrosis of vessel wall involving medium-sized vessels, some of which are seen in the deepest dermis. Leucocytolysis is also seen. Biopsy skin from the leg shows necrotizing leucocytoclastic vasculitis involving medium-sized blood vessels
rkad049f2.jpg
PMC10267297_03_rkad049f2.jpg
rkad049-F2
Ulcer biopsy revealed fibrinoid necrosis in upper dermal vessels, with proliferating blood vessels lined by plump endothelial cells (Fig. 2B).
PMC10267297_04
Comparison of cutaneous PAN ulcers/skin lesions before and after treatment with tofacitinib. (A, B) Patient 1: Livedo racemosa on both lower limbs (pre-ulcerative stage; A) and healed cutaneous lesion after 12 weeks of tofacitinib treatment (B). (C, D) Patient 2: purpuric lesions on bilateral lower extremities, with pedal oedema (C) and rapid regression of ulcers with scarring after tofacitinib therapy (D). (E, F) Patient 3: left lateral malleolar non-healing superficial ulcer (E) and healed cutaneous ulcers after tofacitinib therapy (F). (G, H) Patient 4: multiple non-healing ulcers on the foot (G) and ulcers healed with fibrosis after tofacitinib therapy (H)
rkad049f1.jpg
PMC10267297_04_rkad049f1.jpg
rkad049-F1
A 32-year-old female patient presented with multiple pruritic purpuric rashes and non-healing ulcers on the foot (Fig. 1G). The ulcers healed with fibrosis and scarring [Fig. 1H].