Primary cutaneous small vessel vasculitis: approach to diagnosis and treatment

Russell, James P.; Gibson, Lawrence E.

doi:10.1111/j.1365-4632.2005.02898.x

Cited by 98 publications

(135 citation statements)

References 61 publications

(166 reference statements)

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“…They feel uncomfortable with using a histological description such as ''leukocytoclasia'' as a clinical diagnosis. [12][13][14] However, many agree with the CHCC concept to describe the disease entity, and find this description easy to understand in the context of vasculitis syndrome. Because the present classification system is based on the CHCC classification, it routinely refers to CLA.…”

Section: Seven Diseases Based On a New Algorithm For Primary Cutaneoumentioning

confidence: 99%

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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Palpable purpura tends to indicate involvement of small vessel vasculitis in the upper dermis. Livedo racemosa, nodular lesion and skin ulceration are indicative of involvement of small to medium-sized vessel vasculitis in the lower dermis to subcutaneous fat. We set out to establish a new algorithm (KAWAKAMI algorithm) for primary cutaneous vasculitis based on the Chapel Hill Consensus Conference classification and our research results, and apply to the diagnosis. The first step is to measure serum antineutrophil cytoplasmic antibodies (ANCA) levels. If myeloperoxidase-ANCA is positive, Churg-Strauss syndrome or microscopic polyangiitis can be suspected, and if the patient is positive for proteinase 3-ANCA, Wegener's granulomatosis is most likely. Next, if cryoglobulin is positive, cryoglobulinemic vasculitis should be suspected. Third, if direct immunofluorescence of the skin biopsy specimen reveals immunoglobulin A deposition within the affected vessels, Henoch-Schö nlein purpura is indicated. Finally, the presence of anti-phosphatidylserine-prothrombin complex antibodies and ⁄ or lupus anticoagulant and histopathological necrotizing vasculitis in the upper to middle dermis (leukocytoclastic vasculitis) indicates cutaneous leukocytoclastic angiitis, whereas if necrotizing vasculitis exists in the lower dermis and ⁄ or is associated with the subcutaneous fat, cutaneous polyarteritis nodosa is indicated. The KAWAKAMI algorithm may allow us to refine our earlier diagnostic strategies and allow for efficacious treatment of primary cutaneous vasculitis. In cutaneous polyarteritis nodosa, warfarin or clopidogrel therapies should be administrated, and in cases that have associated active inflammatory lesions, corticosteroids or mizoribine (mycophenolate mofetil) therapy should be added. We further propose prophylactic treatment of renal complications in patients with Henoch-Schö nlein purpura.

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Section: Seven Diseases Based On a New Algorithm For Primary Cutaneoumentioning

confidence: 99%

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Kawakami

2010

The Journal of Dermatology

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“…Infections leading to leukocytoclastic vasculitis include viral infections (hepatitis B, hepatitis C, HIV), bacterial infections (streptococcus, staphylococci, mycobacteria), fungal infections (chlamydia, candida) and protozoal infections [9]. Our patient did not have an infectious (gastroenteritis, urinary system infection, upper respiratory tract infection) story for the past 3 months and also fever was never present.…”

Section: Discussionmentioning

confidence: 68%

Vildagliptin induced cutaneous leukocytoclastic vasculitis: A case report

Sayin¹,

Ömeroğlu²,

Bilgin³

2017

Med-Science

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Vildagliptin is a new generation theurapeutic agent of diabetes mellitus which belongs to dipeptidyl peptidase-IV inhibitor class acting via the incretin hormone system. It has moderate glycemic efficacy, a low propensity of causing hypoglycaemia and it is weight neutral. Overall, Dipeptidyl peptidase-4 (DPP-4) inhibitors are well tolerated. The use of DPP-4 inhibitors has been associated with a slightly increased risk of upper respiratory tract infections. In this article, we report a case of cutaneous leukocytoclastic vasculitis due to probable vildagliptin usage. Vildagliptin which is associated with cutaneous leukocytoclastic vasculitis was not described in the literature before. Physical examination revealed skin rash in the abdomen and thigh region in our patients due to use of the drug. Discontinuation of the drug eliminated the skin rash immediately.

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“…The most common clinical presentation was palpable purpura, [1,5,6] involving dependent areas such as legs, ankles, feet and buttocks seen in 75%% of patients. This was comparable with earlier studies by Sais et al [7] and Ekenstam et al [8] in 89.2 and 62% of cases, respectively.…”

Section: Discussionmentioning

confidence: 99%

Original Artic Le: Leucocytoclastic Vasculitis: A Clinicopathological Study

Sunandini¹,

Prasad²,

Somal³

et al. 2015

jemds

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ABSTRACT:Vasculitis is the inflammation of blood vessels weather it can be arteries, veins or both. In CSVV, the vasculitic process involves just the small blood vessels within the skin, primarily postcapillary venules. The etiology and clinical features are varied but histopathology is characterized by leucocytoclasia. AIMS AND OBJECTIVES: The present study was done to know the spectrum of various cutaneous manifestations and etiology of leucocytoclastic vasculitis. MATERIALS AND METHODS: The study was carried out on patients who were clinically diagnosed as cutaneous vasculitis, attending the outpatient department of dermatology, venereology and leprosy, King George hospital, affiliated to Andhra medical college, Visakhapatnam from January 2013 to December 2013. It is a cross-sectional type of study and a total of 20 cases were studied. INCLUSION CRITERIA: All patients attending to opd, clinically diagnosed as cutaneous vasculitis irrespective of age and sex were included in study. EXCLUSION CRITERIA: Patients with thrombocytopenic purpura, disorders of coagulation and on warfarin/heparin treatment. RESULTS: Out of 20 patients enrolled in study, most common age group is in between 20-40 years, female preponderance, and most of patients, 75% presented acutely with lesions less than 6 weeks duration, 70% of patients had symptoms of burning and itching in lesions, 40% had history of low grade fever, 45% had arthralgias, 50% had gastrointestinal symptoms, 20% had history of sore throat, 10% had history of significant drug exposure within 6 weeks of onset of lesions. Majority of patients had elevated ESR (75%). 25% of patients had ASO titres positive, of which only 15% has throat swab positive for beta-hemolytic streptococci, ANA titres were positive in 5%, renal involvement in the form of albuminuria was seen in 20%, hematuria in 10%, urinary tract infection in 10% of cases, histopathology of all patients showed leucocytoclastic vasculitis. CONCLUSION: In the present study leucocytoclastic vasculitis secondary to infections is most common etiology found, so infections like sore throat and urinary tract infections should be ruled out as prompt treatment resolves vasculitis.

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Primary cutaneous small vessel vasculitis: approach to diagnosis and treatment

Cited by 98 publications

References 61 publications

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis

Vildagliptin induced cutaneous leukocytoclastic vasculitis: A case report

Original Artic Le: Leucocytoclastic Vasculitis: A Clinicopathological Study

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