Papulonecrotic angiitis of Werther—Werner—Duemling while taking NSAIDs

The problem of vascular pathology of the skin remains one of the relevant topics in modern practical dermatology, which is associated with the relative rarity of the disease, polyetiology and polymorphism of clinical manifestations that impede timely diagnosis. Angiitis (vasculitis) of the skin is a disease in the clinical and pathomorphological symptoms of which the initial and leading link is nonspecific inflammation of the walls of dermal and hypodermal blood vessels of various calibers. Trigger factors for the development of pathology can be systemic diseases of the connective tissue (systemic lupus erythematosus, rheumatoid arthritis, scleroderma, dermatopolymiosis, Sjogren’s syndrome, etc.), various infectious processes (sepsis, infectious endocarditis, syphilis, HIV, hepatitis B, C, cytomegalovirus), malignant tumors (usually hemo-blastosis), as well as drug sensitization. Papulonecrotic vasculitis (necrotic nodular angiitis of Werther—Werner—Duemling) refers to dermal vasculitis, therefore, it mainly affects small-caliber vessels. It is quite possible the transformation of skin vasculitis into a systemic process with damage to internal organs and the development of severe complications. Angiitis refers to polyethiological dermatoses, however, the allergic component is decisive in the development of the disease, one of the reasons for which may be taking medications. We present the case of the polymorphic dermal vasculitis of the papulonecrotic type Werther—Werner—Duemling, caused by taking non-steroidal anti-inflammatory drugs (NSAIDs) in a 59-year-old woman. It is known that long-term use of drugs such as cuprenyl, allopurinol, thiazide diuretics, ketorola-cum, aurum medications, sulfonamides, phenytoin, penicillins, amphetamine, can cause vasculitis. In the modern literature, isolated cases of the occurrence of this pathology are described against the background of the use of NSAIDs, such as ketorolac, naproxen and ibuprofen. Given the fairly popular and often uncontrolled use of NSAIDs, it is important to consider the potential side effect of this group of drugs. © 2020, Media Sfera. All rights reserved