Hypersensitivity Vasculitis Follow-up

  • Author: Jeffrey P Callen, MD; Chief Editor: William D James, MD   more...
 
Updated: May 2, 2012
 

Further Inpatient Care

In hypersensitivity vasculitis (leukocytoclastic vasculitis), inpatient care is needed for patients who have severe vasculitic syndromes with multiple organ dysfunction. Most patients with cutaneous vasculitis are treated in an outpatient setting.

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Further Outpatient Care

Design of a follow-up program depends on the vasculitic syndrome, its chronicity, and the organ systems affected. Further follow-up care may not be needed once the process is inactive in a patient with hypersensitivity vasculitis.

Patients with Henoch-Schönlein purpura may develop impairment of renal function or hypertension; regular follow-up care, even after complete clearing of disease, is needed.[23]

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Inpatient & Outpatient Medications

Management of patients with chronic cutaneous vasculitis is a challenge. Dietary restriction may be tried in absence of an identifiable cause. Colchicine (0.6 mg bid) and/or dapsone (100-200 mg/d) may control disease. Other agents (including immunosuppressive/cytotoxic agents) may be administered in patients with unresponsive or poorly responsive conditions.

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Transfer

Consider transfer to a tertiary care facility for patients with severe visceral disease. Patients with chronic cutaneous disease are often referred to a tertiary care center for specialty care.

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Complications

Vasculitis may be complicated by ulceration of skin or by end-organ dysfunction.

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Prognosis

The prognosis of patients with cutaneous vasculitis depends on the underlying syndrome or the presence of end-organ dysfunction, as follows:

  • Patients with disease that primarily affects the skin and/or the joints have a good prognosis.
  • Patients with Wegener granulomatosis, polyarteritis nodosa, Churg-Strauss syndrome, or severe necrotizing vasculitis have a potentially fatal disease. Treatments with corticosteroids and/or immunosuppressive/cytotoxic agents often save the patient's life.
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Contributor Information and Disclosures
Author

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Celgene Honoraria Safety Monitoring Committee

Specialty Editor Board

Michelle Pelle, MD  Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California, San Diego, School of Medicine

Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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Hypersensitivity vasculitis.
Henoch-Schönlein purpura.
Histopathologic features of leukocytoclastic vasculitis.
Urticarial vasculitis. These lesions differ from routine hives by lasting longer (often >24 h), being less pruritic, and often resolving with a bruise or residual pigmentation.
Erythema elevatum diutinum, a rare cutaneous vasculitis.
 
 
 
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