eMedicine Specialties > Dermatology > Diseases of the Vessels

Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis): Follow-up

Author: Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: Mar 4, 2009

Follow-up

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 on an outpatient basis.

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.21

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.

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.

Complications

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

Prognosis

  • The prognosis of patients with cutaneous vasculitis depends on the underlying syndrome or the presence of end-organ dysfunction.
  • 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.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis of vasculitis in patients with a nonvasculitic disorder (eg, insect bite reaction)
  • Failure to recognize serious systemic disease
  • Failure to inform patients of the risks associated with therapy (eg, corticosteroid-induced avascular necrosis)
  • Overaggressive treatment of patients with chronic, but mild disease may cause complications
  • Undertreatment of patients with severe systemic disease may cause complications
 


More on Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)

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Follow-up: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
Multimedia: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
References
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References

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Further Reading

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Keywords

hypersensitivity vasculitis, leukocytoclastic vasculitis, LCV, allergic angiitis, small-vessel vasculitis, small vessel vasculitis, Henoch-Schönlein purpura, acute hemorrhagic edema, hypocomplementemic urticarial vasculitis, livedo reticularis, cutaneous vasculitis, upper respiratory tract infections, beta-hemolytic streptococcal infection, viral hepatitis, HIV infection, hepatitis B, hepatitis C, collagen vascular disease, rheumatoid arthritis, Sjögren syndrome, lupus erythematosus, inflammatory bowel disease, ulcerative colitis, Crohn colitis

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Contributor Information and Disclosures

Author

Jeffrey P Callen, MD, Professor of Medicine, 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; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

Medical Editor

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

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
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; american college of physicians Honoraria Other

 
 
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