Q:

6/8/2014
A number of patients with chronic urticaria report a slight residual erythema or slight darkening without actual bruising, after their hives resolve. Is this slight darkening suggestive of vasculitis?

A:

Thank you for your inquiry.

Yes, as you can see from the abstract copied below, residual pigmentation or bruising following resolution of an urticarial lesion has traditionally been considered a sign of urticarial vasculitis. It does not establish the diagnosis, however, since it can occur in non-vasculitic lesions as well. However, it does raise the index of suspicion that an underlying vasculitis may be responsible for the skin lesions. Two other classical physical manifestations suggesting a vasculitic lesion are persistence of the hives at the same spot for greater than 24 hours, and burning and stinging as opposed to itching.

Thank you again for your inquiry and we hope this response is helpful to you.

Actas Dermosifiliogr. 2013 Sep;104(7):579-85. doi: 10.1016/j.adengl.2012.12.005. Epub 2013 Jul 23.
Urticarial vasculitis: a retrospective study of 15 cases.
Moreno-Suárez F1, Pulpillo-Ruiz Á, Zulueta Dorado T, Conejo-Mir Sánchez J.
Author information
1Servicio de Dermatología, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
Abstract
Introduction: Urticarial vasculitis is a subtype of vasculitis characterized clinically by urticarial lesions and histologically by necrotizing vasculitis.
Objective: To study the clinical and histologic features of urticarial vasculitis in patients seen in the dermatology department of Hospital Universitario Virgen de Rocío in Seville, Spain, and to examine the association between hypocomplementemia and systemic disease.
Material and Methods: We performed a chart review of histologically confirmed cases of urticarial vasculitis in the database of our department covering a period of 10 years.
Results: Fifteen patients (9 women and 6 men with a median age of 51 years) were included. In 14 patients (93%), the lesions persisted for more than 24hours, and in 9 cases (60%) the lesions resolved leaving residual purpura or hyperpigmentation. Seven patients (47%) had low complement levels in the blood, 12 (80%) had extracutaneous symptoms, and 8 (53%) had associated systemic disease, the most common of which was systemic lupus erythematosus.
Conclusions: Urticarial vasculitis may be underdiagnosed. Response to treatment is variable, and hypocomplementemia and extracutaneous symptoms may indicate the presence of associated systemic disease.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology