Hypersensitivity Vasculitis Medication

  • Author: Mital Patel, MD; Chief Editor: William D James, MD  more...
Updated: May 03, 2016

Medication Summary

No standard therapeutic protocol exists for hypersensitivity vasculitis. In addition, few of the therapies currently used for this entity have been tested in controlled trials.



Class Summary

These agents decrease inflammatory responses and systemically interfere with events leading to inflammation.



Colchicine has effects against neutrophils, which are involved in the pathogenesis of hypersensitivity vasculitis. Colchicine has been demonstrated to be steroid-sparing in open-label studies. The only double-blinded placebo-controlled trial failed to demonstrate its efficacy; however, several methodological errors occurred in this study. It is not FDA approved in children.

Dapsone (Avlosulfon)


Small open-label studies or single case reports have suggested that dapsone is effective in some patients with cutaneous vasculitis. Dapsone is used in hypersensitivity vasculitis not for its antimicrobial activity but for its modulatory effect on neutrophil activity.



Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Prednisone (Deltasone)


Prednisone is indicated for vasculitis affecting internal organs (eg, kidneys, lungs, CNS). Patients with bullous skin lesions require corticosteroid therapy in order to prevent cutaneous ulceration.



Class Summary

These agents inhibit cell growth and proliferation. Agents in this class possibly used in hypersensitivity vasculitis include cyclophosphamide, azathioprine, methotrexate, rituximab, and mycophenolate.

Cyclophosphamide (Cytoxan, Neosar)


Cyclophosphamide is useful in life-threatening cases of vasculitis. Patients with skin-limited disease generally should not be treated with this agent. It is useful in patients with granulomatosis with polyangiitis (formerly Wegener granulomatosis), polyarteritis nodosa, or eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome). Cyclophosphamide is an alkylating agent that depresses T- and B-cell function.

Azathioprine (Imuran)


Azathioprine antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. It may decrease the proliferation of immune cells, which results in lower autoimmune activity.

Methotrexate (Folex, Rheumatrex)


Methotrexate inhibits 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) tranformylase, which leads to increased levels of adenosine. This increase in adenosine inhibits leukocyte accumulation, thereby decreasing inflammation. Methotrexate ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). Adjust the dose gradually to attain a satisfactory response.

Rituximab (Rituxan)


Rituximab is a genetically engineered human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. It immunomodulates response against malignant cells.

Mycophenolate (CellCept)


Mycophenolate inhibits inosine monophosphate dehydrogenase (IMPDH) and suppresses de novo purine synthesis by lymphocytes, thereby inhibiting their proliferation. Inhibits antibody production.

Contributor Information and Disclosures

Mital Patel, MD Instructor of Dermatology, Harvard Medical School; Associate Physician, Assistant Program Director of Dermatology-Rheumatology Fellowship, Department of Dermatology, Brigham and Women’s Hospital

Mital Patel, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Womens Association, Dermatology Foundation, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, Medical Dermatology Society, Rheumatologic Dermatology Society, Women's Dermatologic Society

Disclosure: Nothing to disclose.


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, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Ruth Ann Vleugels, MD, MPH Assistant Professor of Dermatology, Harvard Medical School; Associate Physician, Department of Dermatology, Brigham and Women's Hospital; Associate Physician, Department of Immunology and Allergy, Children's Hospital Boston

Ruth Ann Vleugels, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Rheumatology, American Medical Association, Society for Investigative Dermatology, Medical Dermatology Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, 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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

  1. Mackel SE, Jordon RE. Leukocytoclastic vasculitis. A cutaneous expression of immune complex disease. Arch Dermatol. 1982 May. 118(5):296-301. [Medline].

  2. Kevil CG, Bullard DC. Roles of leukocyte/endothelial cell adhesion molecules in the pathogenesis of vasculitis. Am J Med. 1999 Jun. 106(6):677-87. [Medline].

  3. Arora A, Wetter DA, Gonzalez-Santiago TM, Davis MD, Lohse CM. Incidence of leukocytoclastic vasculitis, 1996 to 2010: a population-based study in Olmsted County, Minnesota. Mayo Clin Proc. 2014 Nov. 89 (11):1515-24. [Medline].

  4. Blanco R, Martinez-Taboada VM, Rodriguez-Valverde V, Garcia-Fuentes M. Cutaneous vasculitis in children and adults. Associated diseases and etiologic factors in 303 patients. Medicine (Baltimore). 1998 Nov. 77(6):403-18. [Medline].

  5. Garcia-Porrua C, Gonzalez-Gay MA. Comparative clinical and epidemiological study of hypersensitivity vasculitis versus Henoch-Schönlein purpura in adults. Semin Arthritis Rheum. 1999 Jun. 28(6):404-12. [Medline].

  6. Garcia-Porrua C, Gonzalez-Gay MA, Lopez-Lazaro L. Drug associated cutaneous vasculitis in adults in northwestern Spain. J Rheumatol. 1999 Sep. 26(9):1942-4. [Medline].

  7. Gonzalez-Gay MA, Garcia-Porrua C, Pujol RM. Clinical approach to cutaneous vasculitis. Curr Opin Rheumatol. 2005 Jan. 17(1):56-61. [Medline].

  8. Gonzalez-Gay MA, Garcia-Porrua C. Systemic vasculitis in adults in northwestern Spain, 1988-1997. Clinical and epidemiologic aspects. Medicine (Baltimore). 1999 Sep. 78(5):292-308. [Medline].

  9. Chen KR, Carlson JA. Clinical approach to cutaneous vasculitis. Am J Clin Dermatol. 2008. 9(2):71-92. [Medline].

  10. Fiorentino DF. Cutaneous vasculitis. J Am Acad Dermatol. 2003 Mar. 48(3):311-40. [Medline].

  11. Sams WM Jr. Hypersensitivity angiitis. J Invest Dermatol. 1989 Aug. 93(2 Suppl):78S-81S. [Medline].

  12. Zurada JM, Ward KM, Grossman ME. Henoch-Schönlein purpura associated with malignancy in adults. J Am Acad Dermatol. 2006 Nov. 55(5 Suppl):S65-70. [Medline].

  13. Solans-Laque R, Bosch-Gil JA, Perez-Bocanegra C, Selva-O'Callaghan A, Simeon-Aznar CP, Vilardell-Tarres M. Paraneoplastic vasculitis in patients with solid tumors: report of 15 cases. J Rheumatol. 2008 Feb. 35(2):294-304. [Medline].

  14. Fain O, Hamidou M, Cacoub P, et al. Vasculitides associated with malignancies: analysis of sixty patients. Arthritis Rheum. 2007 Dec 15. 57(8):1473-80. [Medline].

  15. Xu LY, Esparza EM, Anadkat MJ, Crone KG, Brasington RD. Cutaneous manifestations of vasculitis. Semin Arthritis Rheum. 2009 Apr. 38(5):348-60. [Medline].

  16. Piette WW, Stone MS. A cutaneous sign of IgA-associated small dermal vessel leukocytoclastic vasculitis in adults (Henoch-Schönlein purpura). Arch Dermatol. 1989 Jan. 125(1):53-6. [Medline].

  17. Loricera J, Calvo-Río V, Mata C, Ortiz-Sanjuán F, González-López MA, Alvarez L, et al. Urticarial vasculitis in northern Spain: clinical study of 21 cases. Medicine (Baltimore). 2014 Jan. 93(1):53-60. [Medline].

  18. Davis MD, Daoud MS, Kirby B, Gibson LE, Rogers RS 3rd. Clinicopathologic correlation of hypocomplementemic and normocomplementemic urticarial vasculitis. J Am Acad Dermatol. 1998 Jun. 38(6 Pt 1):899-905. [Medline].

  19. Wisnieski JJ, Baer AN, Christensen J, et al. Hypocomplementemic urticarial vasculitis syndrome. Clinical and serologic findings in 18 patients. Medicine (Baltimore). 1995 Jan. 74(1):24-41. [Medline].

  20. Fujikawa K, Kawakami A, Hayashi T, et al. Cutaneous vasculitis induced by TNF inhibitors: a report of three cases. Mod Rheumatol. 2010 Feb. 20(1):86-9. [Medline].

  21. Lowry MD, Hudson CF, Callen JP. Leukocytoclastic vasculitis caused by drug additives. J Am Acad Dermatol. 1994 May. 30(5 Pt 2):854-5. [Medline].

  22. Pendergraft WF 3rd, Niles JL. Trojan horses: drug culprits associated with antineutrophil cytoplasmic autoantibody (ANCA) vasculitis. Curr Opin Rheumatol. 2014 Jan. 26(1):42-9. [Medline].

  23. Loricera J, Calvo-Rio V, Ortiz-Sanjuan F, Gonzalez-Lamuno D, Martínez-Taboada VM, González-Gay MA, et al. The spectrum of paraneoplastic cutaneous vasculitis in a: defined population. Medicine (Baltimore). 2013. 92:331.

  24. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013 Jan. 65(1):1-11. [Medline].

  25. Callen JP. Colchicine is effective in controlling chronic cutaneous leukocytoclastic vasculitis. J Am Acad Dermatol. 1985 Aug. 13(2 Pt 1):193-200. [Medline].

  26. Sais G, Vidaller A, Jucgla A, Gallardo F, Peyri J. Colchicine in the treatment of cutaneous leukocytoclastic vasculitis. Results of a prospective, randomized controlled trial. Arch Dermatol. 1995 Dec. 131(12):1399-402. [Medline].

  27. Cronstein BN, Naime D, Ostad E. The antiinflammatory effects of methotrexate are mediated by adenosine. Adv Exp Med Biol. 1994. 370:411-6. [Medline].

  28. Bangert CA, Costner MI. Methotrexate in dermatology. Dermatol Ther. 2007 Jul-Aug. 20(4):216-28. [Medline].

  29. Keogh KA, Ytterberg SR, Fervenza FC, Carlson KA, Schroeder DR, Specks U. Rituximab for refractory Wegener's granulomatosis: report of a prospective, open-label pilot trial. Am J Respir Crit Care Med. 2006 Jan 15. 173(2):180-7. [Medline]. [Full Text].

  30. Chung L, Funke AA, Chakravarty EF, Callen JP, Fiorentino DF. Successful use of rituximab for cutaneous vasculitis. Arch Dermatol. 2006 Nov. 142(11):1407-10. [Medline].

  31. Harper L. Recent advances to achieve remission induction in antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Rheumatol. 2010 Jan. 22(1):37-42. [Medline].

  32. Lunardi C, Bambara LM, Biasi D, Zagni P, Caramaschi P, Pacor ML. Elimination diet in the treatment of selected patients with hypersensitivity vasculitis. Clin Exp Rheumatol. 1992 Mar-Apr. 10(2):131-5. [Medline].

  33. Tancrede-Bohin E, Ochonisky S, Vignon-Pennamen MD, Flageul B, Morel P, Rybojad M. Schönlein-Henoch purpura in adult patients. Predictive factors for IgA glomerulonephritis in a retrospective study of 57 cases. Arch Dermatol. 1997 Apr. 133(4):438-42. [Medline].

  34. Callen JP. Cutaneous vasculitis: Relationship to systemic disease and therapy. Curr Probl Dermatol. 1993. 5:45-80.

  35. Ekenstam Eaf, Callen JP. Cutaneous leukocytoclastic vasculitis. Clinical and laboratory features of 82 patients seen in private practice. Arch Dermatol. 1984 Apr. 120(4):484-9. [Medline].

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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