Hypersensitivity Vasculitis Medication

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

Medication Summary

No established, effective therapy is available for all patients. Few of the therapies have been tested in controlled trials.

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Anti-inflammatories

Class Summary

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

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Colchicine

 

Has effects against neutrophils, which are probably involved in expression of cutaneous vasculitis; 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. Not FDA approved in children.

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Dapsone (Avlosulfon)

 

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

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Corticosteroids

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.

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Prednisone (Deltasone)

 

Indicated for vasculitis affecting internal organs (eg, kidneys, lungs, CNS). Patients whose skin involvement results in ulceration may require corticosteroid therapy.

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Cytotoxic/immunosuppressives

Class Summary

These agents inhibit cell growth and proliferation. Note the clinical guideline summary, Guidelines for prescribing azathioprine in dermatology.

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Cyclophosphamide (Cytoxan, Neosar)

 

Useful in life-threatening cases of vasculitis. Patients with only skin disease generally should not be treated with this agent. Useful in patients with polyarteritis nodosa, Wegener granulomatosis, and Churg-Strauss syndrome. Agent is an alkylating agent that depresses T- and B-cell function.

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Azathioprine (Imuran)

 

Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity.

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Methotrexate (Folex, Rheumatrex)

 

Unknown mechanism of action in treatment of inflammatory reactions; may affect immune function. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness).

Adjust dose gradually to attain satisfactory response.

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Rituximab (Rituxan)

 

Genetically engineered human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes.

Immunomodulates response against malignant cells.

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Mycophenolate (CellCept)

 

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

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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

References

  1. Mackel SE, Jordon RE. Leukocytoclastic vasculitis. A cutaneous expression of immune complex disease. Arch Dermatol. May 1982;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. Jun 1999;106(6):677-87. [Medline].

  3. 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). Nov 1998;77(6):403-18. [Medline].

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

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

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

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

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

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

  10. 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. Feb 2008;35(2):294-304. [Medline].

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

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

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

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

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

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

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

  18. 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. Dec 1995;131(12):1399-402. [Medline].

  19. 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. Jan 15 2006;173(2):180-7. [Medline].

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

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

  22. 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. Mar-Apr 1992;10(2):131-5. [Medline].

  23. 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. Apr 1997;133(4):438-42. [Medline].

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

  25. Carlson JA, Cavaliere LF, Grant-Kels JM. Cutaneous vasculitis: diagnosis and management. Clin Dermatol. Sep-Oct 2006;24(5):414-29. [Medline].

  26. Carlson JA, Ng BT, Chen KR. Cutaneous vasculitis update: diagnostic criteria, classification, epidemiology, etiology, pathogenesis, evaluation and prognosis. Am J Dermatopathol. Dec 2005;27(6):504-28. [Medline].

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

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

  29. Jennette JC, Falk RJ. Small-vessel vasculitis. N Engl J Med. Nov 20 1997;337(21):1512-23. [Medline].

  30. Lie JT. Nomenclature and classification of vasculitis: plus ça change, plus c'est la même chose. Arthritis Rheum. Feb 1994;37(2):181-6. [Medline].

  31. Lotti T, Ghersetich I, Comacchi C, Jorizzo JL. Cutaneous small-vessel vasculitis. J Am Acad Dermatol. Nov 1998;39(5 Pt 1):667-87; quiz 688-90. [Medline].

  32. Martinez-Taboada VM, Blanco R, Garcia-Fuentes M, Rodriguez-Valverde V. Clinical features and outcome of 95 patients with hypersensitivity vasculitis. Am J Med. Feb 1997;102(2):186-91. [Medline].

  33. Russell JP, Weenig RH. Primary Cutaneous Small Vessel Vasculitis. Curr Treat Options Cardiovasc Med. Apr 2004;6(2):139-149. [Medline].

  34. Sanchez-Guerrero J, Gutierrez-Urena S, Vidaller A, Reyes E, Iglesias A, Alarcon-Segovia D. Vasculitis as a paraneoplastic syndrome. Report of 11 cases and review of the literature. J Rheumatol. Nov 1990;17(11):1458-62. [Medline].

 
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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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