Hypersensitivity Vasculitis Treatment & Management

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

Medical Care

Once a diagnosis of hypersensitivity vasculitis (leukocytoclastic vasculitis) is established and the patient is fully evaluated, specific or nonspecific management options may be used.

  • Elevation of the legs or compression stockings may be useful because the disease often affects dependent areas.
  • Treat the cause in patients with an identifiable cause. Removal of a drug thought to be causing the vasculitis may result in rapid clearing of the process in up to 2 weeks.
  • Treat chronic disease that primarily involves the skin with nontoxic modalities whenever possible; avoid using systemic corticosteroids and/or immunosuppressive agents. Colchicine[17, 18] or dapsone may be administered for patients with disease of the skin with or without joint manifestations.
  • Patients with urticarial lesions may be treated with antihistamines (both soporific ones and less sedating agents). Sometimes, a combination of these agents is needed to control disease manifestations. Some patients have responded to nonsteroidal anti-inflammatory agents.
  • Patients with severe visceral involvement may require high doses of corticosteroids (1-2 mg/kg/d) with or without an immunosuppressive agent (eg, cyclophosphamide, azathioprine, methotrexate, mycophenolate mofetil).
  • Rituximab use has been reported in various subsets of vasculitis patients, particularly those with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. Several patients with chronic cutaneous small-vessel vasculitis have also been treated effectively with this agent.[19, 20, 21]
  • Consider a restrictive diet for patients with chronic cutaneous vasculitis without other identifiable causes.[22]
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Surgical Care

Surgical care is rarely needed for patients with hypersensitivity vasculitis (leukocytoclastic vasculitis). Surgical care may be appropriate if a tumor is identified as a cause of the process. Surgical care also may be appropriate if recalcitrant ulceration occurs after control of active disease.

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Consultations

  • Rheumatologist
  • Dermatologist
  • Nephrologist
  • Gastroenterologist/hepatologist
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Diet

No specific diet is required. A restrictive diet may be used for up to 2 weeks for diagnostic and therapeutic purposes.[22]

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Activity

No specific restrictions on activity are recommended.

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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

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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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