fig2

Figure 2. Cutaneous manifestations of cryoglobulinemic vasculitis. (A) Orthostatic purpura rash involving the lower extremities. Purpuric lesions show diverse phases of evolution, combining more acute (erythematous macules) and residual (brownish) hyperpigmentation. (B) Hemorrhagic blisters and skin ulcers with central necrotic tissue. (C) Distal ischemia and digital necrosis of fingers in severe cryoglobulinemic disease. (D) Cutaneous vasculitis complicated with painful skin ulcer, located at the ankle. (E) Retiform purpura, a rare manifestation of cryoglobulinemia, consisting of branching, nonblanching patch or plaque, usually indicating concomitant small and medium-vessel involvement.