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)

Overview: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
Differential Diagnoses & Workup: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
Treatment & Medication: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
Follow-up: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
Multimedia: Hypersensitivity Vasculitis (Leukocytoclastic Vasculitis)
References

References

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Further Reading

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

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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