Medical Care
Urticarial vasculitis tends to run a chronic course. Mortality is low, unless renal or pulmonary disease occurs. The goal of treatment is to achieve long-term control with the least amount of toxicity. [25, 26]
A complete patient history is the basis for treatment. In the history, ask for time of onset of the lesions; duration of the lesions (eg, >24 h); whether lesions are painful or burning, rather than pruritic; and the history of resolution with purpura or hyperpigmentation. Inquire about the patient's medications, fever, arthralgia, dyspnea, abdominal pain, and symptoms of angioedema. Omalizumab has produced mixed results. [27, 28]
Consultations
Consultation with the following specialists may be needed:
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Dermatologist: Skin biopsy is evaluated by a dermatologist/dermatopathologist to confirm the diagnosis.
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Rheumatologist: Consult a rheumatologist when SLE is suspected or if the patient has the hypocomplementemic variant with systemic symptoms.
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Allergist/immunologist
Long-Term Monitoring
Once a diagnosis of urticarial vasculitis is made, follow-up care depends on the patient's complement levels. If complement level findings are normal, follow patients for symptoms and response to treatment. If complement level findings are low, follow patients for attendant complications related to the cause of their hypocomplementemia (see History).
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Raised erythematous wheals with postinflammatory hyperpigmentations suggest urticarial vasculitis.
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A low-power histologic image of urticarial vasculitis shows leukocytoclastic vasculitis with damage to the vessel wall and a neutrophilic infiltrate.
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A high-power view of the histology of urticarial vasculitis shows extensive fibrin deposition in the vessel walls. Surrounding the vessels is a mixed infiltrate predominately composed of neutrophils with leukocytoclasis.
