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Cutaneous small-vessel vasculitis (also known as "Cutaneous leukocytoclastic angiitis," "Cutaneous leukocytoclastic vasculitis," "Cutaneous necrotizing venulitis," and "Hypersensitivity angiitis"[1]) is a inflammation of small blood vessels, characterized clinically by palpable purpura.[2]:831[3] Subtypes of small-vessel vasculitis include:[2]:833-6

See also

References

  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.  
  2. ^ a b James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.  
  3. ^ Lotti T, Ghersetich I, Comacchi C, Jorizzo JL (November 1998). "Cutaneous small-vessel vasculitis". J. Am. Acad. Dermatol. 39 (5 Pt 1): 667–87; quiz 688–90. PMID 9810883.  

Hypersensitivity vasculitis
Classification and external resources
ICD-10 M31.0
ICD-9 446.2
DiseasesDB 7423
eMedicine med/2930 
MeSH D018366

Hypersensitivity vasculitis (or hypersensitivity angiitis or leukocytoclastic vasculitis) is a small vessel vasculitis,[1] usually due to a hypersensitivity reaction.

Contents

Causes

True leukocytoclastic vasculitis can be induced by many medications.[2]:126 It is usually due to a known drug (such as cefoperazone[3] or nicoumalone[4]), auto-antigens or infectious agents such as bacteria. Immune complexes lodge in the vessel wall, attracting polymorphonuclear leukocytes who in turn release tissue-degrading substances leading to an inflammatory process.

Clinical Presentation

Palpable, normally painful, petechiae or purpura (skin vasculitis). The lesions normally arise in crops, with common localizations being the forearms and legs. Necrosis of skin tissue can yield lesions with black or brown centres. This disorder may affect the skin only, but sometimes affect nerves, the kidneys, joints and the heart. Renal involvement is common.

Investigations

The primary goal is to identify the causing agent, be it a drug or a microbe. Questioning is important, as is a thorough physical examination, chest X-ray, ESR and biochemical organ tests. Skin biopsy of the lesions reveal inflammation of the small vessels, termed leukocytoclastic vasculitis, which is most prominent in postcapillary venules. Tests for hepatitis virus, antinuclear antibodies, rheumatoid factor and cryoglobulins might be indicated.

Diagnostic Criteria

At least 3 out of 5 criteria yields a sensitivity of 71% and a specificity of 84%:

  • Age > 16.
  • Use of possible triggering drug in relation to symptoms.
  • Palpable painful purpura (the three P's).
  • Maculopapular rash.
  • Skin biopsy showing neutrophil infiltration around vessel.

Some instances consider Henoch-Schönlein purpura as a separate disorder,[5] just as with cutaneous small-vessel vasculitis.[6] Other consider hypersensitivity vasculitis as a symptom complex, for which Henoch-Schönlein purpura is a potential cause.[7][8]

Treatment

The most important part of the treatment is to eliminate the cause of the vasculitis, if at all possible. Antihistamines prove helpful to some patients. If the vasculitis is damaging organ systems such as the kidneys, immunosuppressive agents are indicated.

See also

References

  1. hypersensitivity vasculitis at Dorland's Medical Dictionary
  2. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0721629210.
  3. Islek I, Baris S, Katranci AO, Ariturk E, Gurses N (January 2003). "Hypersensitivity vasculitis induced by cefoperazone/sulbactam". Ann. Clin. Microbiol. Antimicrob. 2: 1. doi:10.1186/1476-0711-2-1. PMID 12556245. PMC: 149382. http://www.ann-clinmicrob.com/content/2//1. 
  4. Susano R, Garcia A, Altadill A, Ferro J (April 1993). "Hypersensitivity vasculitis related to nicoumalone". BMJ 306 (6883): 973. doi:10.1136/bmj.306.6883.973-a. PMID 8490477. 
  5. Michel BA, Hunder GG, Bloch DA, Calabrese LH (1992). "Hypersensitivity vasculitis and Henoch-Schönlein purpura: a comparison between the 2 disorders". J. Rheumatol. 19 (5): 721–8. PMID 1613701. 
  6. Amoli MM, Thomson W, Hajeer AH, et al. (May 2002). "Henoch-Schönlein purpura and cutaneous leukocytoclastic angiitis exhibit different HLA-DRB1 associations". J. Rheumatol. 29 (5): 945–7. PMID 12022354. 
  7. Courtney PA, Patterson RN, Lee RJ (March 2001). "Henoch-Schönlein purpura following meningitis C vaccination". Rheumatology (Oxford) 40 (3): 345–6. PMID 11285387. 
  8. Kraft DM, Mckee D, Scott C (1998). "Henoch-Schönlein purpura: a review". Am Fam Physician 58 (2): 405–8, 411. PMID 9713395. http://www.aafp.org/afp/980800ap/kraft.html. 
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