Hypersensitivity vasculitis

Other Names: Leukocytoclastic angiitis; Cutaneous leukocytoclastic angiitis; Cutaneous leukocytoclastic vasculitis; Cutaneous small vessel vasculitis; Hypersensitivity angiitis

Hypersensitivity vasculitis is an extreme reaction to a drug, infection, or foreign substance that leads to inflammation and damage to blood vessels of the skin. The term is not used much currently because more specific names are considered more precise.

Causes

Hypersensitivity vasculitis, or cutaneous small vessel vasculitis, is caused by:

• An allergic reaction to a drug or other foreign substance
• A reaction to an infection

It usually affects people older than age 16. Often, the cause of the problem cannot be found even with a careful study of medical history. Hypersensitivity vasculitis may look like systemic, necrotizing vasculitis, which can affect blood vessels throughout the body and not just in the skin. In children, it can look like Henoch-Schonlein purpura.

Signs and symptoms

Signs and symptoms may include purple-colored spots and patches on the skin; skin lesions on the legs, buttocks, or trunk; blisters on the skin; hives (urticaria); and/or open sores with dead tissue (necrotic ulcers).

For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed.

80%-99% of people have these symptoms

• Cutis marmorata
• Erythema
• Fever
• Gangrene(Death of body tissue due to lack of blood flow or infection)
• Myalgia(Muscle ache)
• Papule
• Purpura(Red or purple spots on the skin)
• Recurrent skin infections(Skin infections, recurrent)
• Urticaria(Hives)
• Vasculitis(Inflammation of blood vessel)

30%-79% of people have these symptoms

• Arthralgia(Joint pain)
• Skin rash

5%-29% of people have these symptoms

• Abnormal oral cavity morphology(Abnormality of the oral cavity)
• Subcutaneous nodule(Firm lump under the skin)

Diagnosis

The health care provider will base the diagnosis on symptoms. The provider will review any medicines or drugs you have taken and recent infections. You will be asked about cough, fever, or chest pain.

A complete physical exam will be done. Blood and urine tests may be done to look for systemic disorders such systemic lupus erythematosus, dermatomyositis, or hepatitis C. The blood tests may include:

• Complete blood count with differential
• Erythrocyte sedimentation rate
• Chemistry panel with liver enzymes and creatinine
• Antinuclear antibody (ANA)
• Rheumatoid factor
• Antineutrophil cytoplasmic antibodies (ANCA)
• Complement levels
• Cryoglobulins
• Hepatitis B and C tests
• HIV test
• Urinalysis
• Skin biopsy shows inflammation of the small blood vessels.

Treatment

The goal of treatment is to reduce inflammation.

Your provider may prescribe aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids to reduce inflammation of the blood vessels. (DO NOT give aspirin to children except as advised by your provider).

Your provider will tell you to stop taking medicines that could be causing this condition.

Prognosis

Hypersensitivity vasculitis most often goes away over time. The condition may come back in some people. People with ongoing vasculitis should be checked for systemic vasculitis.

Possible Complications Complications may include:

• Lasting damage to the blood vessels or skin with scarring
• Inflamed blood vessels affecting the internal organs

Prevention

DO NOT take medicines that have caused an allergic reaction in the past.