Vasculitis is an inflammation and necrosis of the blood vessels, leading to hemorrhage, ischemia, and infarction.(1–3) Treatment of the condition is entirely dependent on the extent of the disease. In many instances, cutaneous vasculitis is a self-limited condition, relieved by leg elevation, avoidance of standing, and therapy with non-steroidal anti-inflammatory drugs (NSAIDs). However, more extensive or severe disease can prove more difficult to manage.
Treatment of vasculitis should begin with a confirmatory diagnosis to eliminate conditions with a similar appearance. A tissue biopsy may confirm diagnosis of cutaneous vasculitis, and can sometimes be used to identify the type of immunoglobin involved. Once a diagnosis is confirmed histologically, other organ systems should be evaluated to identify potential causative factors.(1)
The first and preferred treatment for cutaneous vasculitis should always be avoidance of triggers known to exacerbate the condition, such as excessive standing, infection, or drugs.(5) For mild recurrent or persistent disease, colchicine and dapsone are first-choice agents.(5)
Severe cutaneous disease requires treatment with systemic corticosteroids or more potent immunosuppression (azathioprine, methotrexate, or cyclophosphamide are typical treatments). A combination of corticosteroids and cyclophosphamide is required therapy for systemic vasculitis, which is associated with a high risk of permanent organ damage or death. Intravenous immunoglobin or plasmapheresis may be useful in the treatment of severe, refractory vasculitis, or in patients who have contraindications to traditional immunosuppression.(4)
New biologic therapies that act via cytokine blockade or lymphocyte depletion, such as the tumor necrosis factor-α inhibitor infliximab and the anti-B-cell antibody rituximab, respectively, appear to offer some benefit in certain settings, such as connective tissue disease and anti-neutrophil cytoplasmic antibody-associated vasculitis.(5)
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- de Araujo T and Kirsner RS. Atypical wounds. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.
- Panuncialman J and Falanga V. Unusual causes of cutaneous ulceration. Surg Clin North Am 2010; 90: 1161-1180.
- Ferreira MC, Junior PT, Carvalho VF and Kamamoto F. Clinics 2006; 61: 571-578.
- Chung L and Fiorentino D. Cutaneous Vasculitis. Orphanet encyclopedia, March 2005 (available from http://www.orpha.net/data/patho/GB/uk-cutaneous-vasculitis.pdf)
- Chen K-R, Carlson JA. Clinical Approach to Cutaneous Vasculitis. Am J Clin Derm 2008; 9: 71-92.