Leukocytoclastic Vasculitis Treatment & Management

Updated: Oct 25, 2018
  • Author: A Brooke W Eastham, MD; Chief Editor: Herbert S Diamond, MD  more...
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Treatment

Medical Care

Once a diagnosis of leukocytoclastic vasculitis (LCV) is established and the patient is fully evaluated, specific or nonspecific management options may be used, including the following [35, 36] :

  • LCV often affects dependent areas; thus, elevation of the legs or compression stockings may be useful

  • Patients with an identifiable cause should receive treatment for that cause. [37] Removal of a drug thought to be causing LCV may result in rapid clearing of the process in as little as 2 weeks

  • In patients with LCV, with or without joint manifestations, colchicine or dapsone may be helpful. [38, 39, 40]

Patients with urticarial lesions may be treated with antihistamines, including both sedating and less-sedating agents. However, these patients may fail to respond to antihistamines, and often a trial of colchicines or dapsone may be needed. In some cases, a combination of these agents is needed to control the disease manifestations. Some patients respond 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). Patients with bullous lesions may require a brief course of systemic corticosteroids in order to gain rapid control and minimize ulcer formation at the sites of bullae.

Patients with chronic LCV may attempt a restrictive elimination diet, which rarely can allow for identification of the cause and control of the disease. [41]

Patients with severe or debilitating disease might also be treated with biologic agents such as rituximab or intravenous immunoglobulin. Of note, these agents are rarely needed for cutaneous LCV.

In a multicenter, randomized, double-blind trial, Stone et al found that rituximab (375 mg/m2/wk for 4 wk) was more efficacious than cyclophosphamide (2 mg/kg/d) for inducing remission of relapsing ANCA-associated vasculitis. Prednisone was gradually tapered downward; 67% of the rituximab group compared with 42% of the cyclophosphamide group reached the primary end point, which was remission of disease without use of prednisone at 6 months (P = 0.01). [42]

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Surgical Care

Surgical care is rarely needed in patients with vasculitis. However, surgery may be appropriate in any of the following circumstances:

  • A tumor is identified as a cause of the process

  • A recalcitrant ulceration persists after the active disease has been controlled

  • An organ biopsy is needed

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Consultations

The following specialty consultations may be indicated:

  • Rheumatologist

  • Dermatologist

  • Nephrologist

  • Gastroenterologist or hepatologist

  • Immunologist or allergist

  • Pulmonologist

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Diet and Activity

No specific diet is required in patients with leukocytoclastic vasculitis. A restrictive elimination diet may be considered for diagnostic and therapeutic purposes. [41]

No specific restrictions on activity are necessary in patients with leukocytoclastic vasculitis. However, leg elevation may be helpful.

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