Spectrum of Cutaneous Vasculitis in Adult Patients from the Farwaniya Region of Kuwait

Abstract

Objective: To determine the clinical profile, etiologic factors, disease associations, and the laboratory profile of adult patients with cutaneous leukocytoclastic vasculitis (LV) presenting to the Dermatology Department at Farwaniya Hospital, Kuwait. Subjects and Methods: The medical records of 57 adult patients (>18 years) with biopsy-proven cutaneous LV from January 2004 to June 2006 at Farwaniya Hospital were reviewed. Results: Of the 57 patients studied, 21 (36.8%) were classified as having primary cutaneous small vessel vasculitis. The most common type of skin lesions found was palpable purpura seen in 29 (50.9%) patients. No possible cause for the cutaneous vasculitis could be identified in 21 patients. Extracutaneous involvement was seen in 32 (56.1%) patients of which 29 had joint involvement. The most frequent laboratory abnormality was an elevated erythrocyte sedimentation rate (ESR). Altered laboratory evaluation in the form of leukocytosis, raised antistreptolysin O titers and urine abnormalities were found in association with systemic vasculitis. IgA deposits were present in 33 patients. Risk factors for chronicity of cutaneous LV were female sex, advanced age, unidentified etiology, absence of fever and presence of joint involvement. Conclusion: The commonest type of LV in Kuwait is primary cutaneous small vessel vasculitis. The most frequent laboratory abnormality associated with LV was increased ESR.

Immunoglobulin-A–associated small-vessel vasculitis: A 10-year experience at the Massachusetts General Hospital

“…15,44 One study found that in an adult population with LCV, IgA deposition within dermal vessels was most often secondary to druginduced hypersensitivity vasculitis rather than HSP. 45 Helander, DeCastro, and Gibson 4 reported that out of 92 cases with cutaneous IgA vascular deposits and impression of vasculitis on DIF (not all showed LCV histologically), HSP was diagnosed in only 24% (other diseases being erythema nodosum, venous stasiserelated skin disease, cryoglobulinemia, coagulopathic vasculopathies, and livedoid vasculitis). They found that 9% of IgA vasculitis cases had 35,38,43,46 and in 18% to 93% of patients with alcoholic liver disease.…”

Vascularites cutanées leucocytoclasiques: à propos de 85 cas

“…La VLC peut survenir à tout âge avec une prédominance de l'âge adulte [1]. En se référant aux données de la littérature, l'âge moyen des patients varie de 42,5 ans à 60 ans [2, 3, 5]. L'âge moyen de nos patients était de 47 ans.…”

“…L'âge moyen de nos patients était de 47 ans. Selon les publications, le sexe ratio hommes/femmes au cours de la VLC varie de 0,7 à 1,8 [2, 3, 5]. Dans notre étude, il existe une prédominance féminine avec un sex-ratio hommes/femmes de 0,6.…”

“…Les signes cutanés peuvent être à type de purpura, d'urticaire, d'ulcères, de papules infiltrées purpuriques, de livedo réticulaire, de nodules et de gangrènes digitales [1, 3, 5]. Les lésions maculopapuleuses purpuriques sont les manifestations cutanées les plus fréquentes des vascularites retrouvées chez 76 à 100% des malades selon les séries [2, 3, 5]. Le purpura était aussi identifié comme le signe clinique le plus sensible au diagnostic de la VLC [3].…”

“…La vascularite leucocytoclasique est associée à un large spectre d'affections systémiques, de néoplasies, d'infections ou à une hypersensibilité médicamenteuse [1]. Plusieurs publications se sont intéressées aux vascularites leucocytoclasiques comme celles faites en Australie par Tai [2] ou au Kuwait par Al-Mutairi [3]. En Tunisie, à notre connaissance, aucune étude sur la VLC n'a été entreprise.…”