Urticarial venulitis

Abstract

Episodes of recurrent urticaria and angioedema may be a clinical manifestation of cutaneous necrotizing venulitis. Known as urticarial vasculitis, this edematous form of necrotizing venulitis occurs in patients with serum sickness, connective tissue disorders, hematologic malignant conditions, an IgMKM component, infections, or physical urticarias after the administration of therapeutic agents, and as an idiopathic disorder. The skin lesions appear as erythematous, occasionally indurated wheals which may contain foci of purpura. Although the individual urticarial lesions may last for less than 24 hours, they often persist up to 3–5 days. The episodes of urticaria are chronic; approximately 70% of the afflicted individuals are women. General features include fever, malaise, and myalgia. Specific organ involvement includes enlargement of the lymph nodes, liver, and spleen and involvement of the synovia, kidneys, gastrointestinal tract, respiratory tract, eyes, and central nervous system. In the treatment of urticarial vasculitis there are no double‐blind, placebo‐controlled trials. Reports exist of the treatment of patients with H1 antihistamines, nonsteroidal anti‐inflammatory agents, colchicine, hydroxychloroquine, dapsone, prednisone, azathioprine, methotrexate, cyclophosphamide, and intramuscular gold therapy.

Hypocomplementemic urticarial vasculitis: a rare presentation of systemic lupus erythematosus

“…Cytotoxic agents, including azathioprine, methotrexate, and cyclophosphamide, alone or in combination with prednisolone, control the disease if used long term. Other treatment options, including antimalarial agents, dapsone, colchicine, and rituximab, may be considered if lesions are refractory 1,4,13,16,19–22 . Unfortunately, pulmonary involvement is difficult to treat and may be fatal, as in our patient 4,13,16 …”

Urticaria and Mastocytosis

“…H1 antihistamines and NSAIDs are the first-line treatment. The second-line treatments include dapsone, colchicine, and/or hydroxychloroquine (Soter 2000). For nonresponder cases, systemic corticosteroids can be used for short-term management (Black 1999).…”

Urticaria: current and future treatments

“…High doses of corticosteroids may be required for UV with systemic involvement. Other drugs have been tried, such as colchicine, dapsone and hydroxychloroquine [118]. They may be used as steroid-sparing agents in order to minimize the dose and toxicity of corticosteroids; however, their own side effects should also be taken into account.…”