eMedicine Specialties > Rheumatology > 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: Jan 15, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is needed in patients who have severe vasculitic syndromes and severe organ dysfunction.
  • Most patients with cutaneous vasculitis are treated in an outpatient setting.

Further Outpatient Care

  • The design of a follow-up program depends on the vasculitic syndrome, its chronicity, and the organ systems affected.
  • Once the process is inactive in a patient with leukocytoclastic vasculitis (LCV), further follow-up care may be unnecessary.
  • Patients with Henoch-Schönlein purpura may develop impaired renal function or hypertension; therefore, regular follow-up care, even after complete clearing of their disease, is needed.

Inpatient & Outpatient Medications

  • Treating patients with chronic cutaneous vasculitis is a challenge.
    • In the absence of an identifiable cause, dietary restriction may be attempted but is usually unsuccessful.
    • Colchicine at 0.6 mg twice daily and/or dapsone at 100-200 mg/d may control the disease. Combination of these two agents seems to be complementary.
    • In patients whose conditions do not respond or respond poorly, other agents, including immunosuppressive or cytotoxic agents, may be administered.
    • Biologic therapies such as intravenous immunoglobulin and rituximab are useful in some patients.

Transfer

  • Transfer to a tertiary care facility should be considered in 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 the skin or by end-organ dysfunction.

Prognosis

  • The prognosis of cutaneous vasculitis depends on the underlying syndrome or the presence of end-organ dysfunction.
  • Patients with disease that primarily affects the skin, joints, or both have a good prognosis.
  • Patients with Wegener granulomatosis, polyarteritis nodosa, Churg-Strauss syndrome, or severe necrotizing vasculitis have a potentially fatal disease. Treatment with corticosteroids and/or immunosuppressive or cytotoxic agents is often lifesaving.

Miscellaneous

Medicolegal Pitfalls

  • Failure to provide an accurate diagnosis (eg, diagnosing vasculitis when the patient has a nonvasculitic disorder [eg, insect-bite reaction])
  • Failure to recognize serious systemic disease
  • Failure to provide proper treatment (eg, overaggressive treatment in a patient with chronic but mild disease or undertreatment of a patient with severe systemic disease)
  • Failure to inform the patient of the risks associated with therapy (eg, corticosteroid-induced avascular necrosis)
  • Failure to recognize an infectious cause (eg, hepatitis C, bacterial endocarditis)
 


More on Leukocytoclastic Vasculitis

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

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Further Reading

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Keywords

leukocytoclastic vasculitis, LCV, hypersensitivity vasculitis, allergic angiitis, small-vessel vasculitis, Henoch-Schonlein purpura, Henoch-Schönlein purpura, serum sickness, serum sickness syndrome, urticarial vasculitis, upper respiratory tract infections, beta-hemolytic streptococci, viral hepatitis, HIV, bacterial endocarditis, hepatitis C, hepatitis B, collagen vascular disease, rheumatoid arthritis, Sjögren syndrome, lupus erythematosus, inflammatory bowel disease, ulcerative colitis, Crohn disease, hairy cell leukemia, cutaneous vasculitis, Wegener granulomatosis, polyarteritis nodosa, microscopic polyarteritis, Churg-Strauss syndrome, erythema elevatum diutinum, hypocomplementemic urticarial vasculitis

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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

Bryan L Martin, DO, Chief, Allergy Immunology Department, Walter Reed Army Medical Center; Associate Professor of Medicine and Pediatrics, Uniformed Services University of the Health Sciences; United States Army Consultant in Allergy Immunology and Immunizations
Bryan L Martin, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; Merck, Amgen, Biogen, Zimmer, Wyeth, Johnson&Johnson, Stryker, Medtronic, Zimmer.Abbott,  Ownership interest Other; West Penn Allegheny Health System Consulting fee Consulting; Alpharma Honoraria Consulting; Proctor&Gamble Grant/research funds Independent contractor

 
 
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