SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

10/31/06

Cutaneous vasculitis

Summary
Background - Cutaneous vasculitis (CV) is not rare, presenting clinically in a number of ways.

Findings - CV clinical manifestations and treatment were reviewed by Carlson et al of the Albany Medical College in New York. CV may be manifested b y some types of urticaria, purpura, ulcers, nodules, livedo or skin infarcts. Most cases of CV are single-episode, self-limited events, generally treated with avoidance of cold temperatures, prolonged standing and tight fitting clothing. Treatment is generally with antihistamines, aspirin or NSAID.

When CV is more pronounced, recurrent and/or associated with signs of systemic vasculitis (e.g. - connective tissues, inflammatory diseases, ANCA-positive vasculitis, certain infections, neoplasms) more aggressive therapy is indicated. When such chronic/recurrent CV is mild, trials of colchicines or dapsone are indicated. More severe CV is treated with corticosteroids and/or cytotoxic immunosuppressive drugs. Infliximab (anti-TNF alpha) and rituximab (anti-B cell) monoclonal antibodies are being assessed in the treatment of CV.

Reference
Clin Dermatol 2006;24:414-29

Editor's Comments
It is important to consider possible CV in cases of recurrent/chronic urticaria in which individual lesions last >24 hours and/or leave residual pigmentation in the site. A biopsy of a fresh lesion is indicated. There is still some debate how effective corticosteroid therapy is in isolated CV (without systemic vasculitis).

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