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Leukocytoclastic Vasculitis Follow-up

  • Author: A Brooke W Eastham, MD; Chief Editor: Herbert S Diamond, MD  more...
 
Updated: Jul 05, 2016
 

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.

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Further Inpatient Care

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

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Inpatient & Outpatient Medications

Treating patients with chronic LCV is a challenge. Considerations include the following:

  • 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 (eg methotrexate, mycophenolate mofetil, azathioprine).
  • Biologic therapies such as intravenous immunoglobulin and rituximab are useful in some patients.
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Transfer

Transfer to a tertiary care facility should be considered in patients with severe visceral disease. Patients with chronic LCV are often referred to a tertiary care center for specialty care.

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Prognosis

The prognosis of cutaneous vasculitis depends on the underlying syndrome or the presence of end-organ dysfunction.[37] Patients with disease that primarily affects the skin, joints, or both have a good prognosis.[38]

Patients with granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome), or severe necrotizing vasculitis have potentially fatal disease. Treatment with corticosteroids and/or immunosuppressive or cytotoxic agents is often lifesaving.

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Contributor Information and Disclosures
Author

A Brooke W Eastham, MD Board Certified Dermatologist, Nashville Skin and Cancer

A Brooke W Eastham, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Dermatology Society

Disclosure: Nothing to disclose.

Coauthor(s)

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

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of 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 for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Janssen<br/>Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Genentech; Pfizer; Questcor.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Bryan L Martin, DO Associate Dean for Graduate Medical Education, Designated Institutional Official, Associate Medical Director, Director, Allergy Immunology Program, Professor of Medicine and Pediatrics, Ohio State University College of Medicine

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, American Osteopathic Association

Disclosure: Nothing to disclose.

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Hypersensitivity vasculitis.
Henoch-Schönlein purpura.
Histopathology of leukocytoclastic vasculitis.
Urticarial vasculitis. Lesions differ from routine urticaria (hives) in that they last longer (often >24 h), are less pruritic, and often resolve with a bruise or residual pigmentation.
Erythema elevatum diutinum, a rare cutaneous vasculitis.
 
 
 
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