Skin necrosis is a clinical manifestation of tissue death, most commonly due to alteration of cutaneous blood flow. Tissue death may occur from blockage, destruction or physiologic constriction of vessels supplying the skin, in either large vessels (peripheral arterial disease) or small vessels (thrombi or emboli), causing ischemia. Vessel destruction may be direct as in vasculitis or indirect as in pyoderma gangrenosum. Cutaneous signs such as purpura and livedo can suggest both presence and type of blood-vessel damage. Vascular studies, biopsy and laboratory tests are important in rendering a diagnosis.
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