Clinicopathological study of cutaneous vasculitides
Keywords:Leukocytoclastic vasculitis, urticarial vasculitis, Henoch-Schonlein purpura, Behcet’s syndrome
AbstractObjective To study the different patterns of cutaneous vasculitides along with their underlying etiologic factors and to assess the clinicopathological correlation. Methods A cross sectional study was conducted on 30 consecutive patients, histologically diagnosed as cutaneous vasculitis in the department of dermatology and venereology, BSMMU, Dhaka. All patients were subjected to a baseline workup consisting of complete hemogram, serum-creatinine levels, liver function tests, chest X-ray, urine (routine and microscopic) examination besides antistreptolysin O titer, antinuclear antibody assay, rheumatoid factor assay, antineutrophilic cytoplasmic antibodies and hepatitis B and C. Histopathological examination was done in all patients while immunofluorescence was done in 9 patients. Results Out of a total of 30 patients diagnosed histologically as cutaneous vasculitis, 22 were classified as cutaneous small vessel vasculitis (CSVV), 6 as Heinoch-Schonlein purpura, and one each as urticarial vasculitis, and Behcet’s syndrome. Approximately 30% of the patients had a significant drug history, 23.3% were attributed to infection. No cause was found in 46.7% cases. Only 9 patients could undergo direct immunofluorescence (DIF), out of which 4 were positive for vasculitis. Conclusion Cutaneous small vessel vasculitis was the commonest type of vaculitis presenting to the dermatology outpatient department. The workup of patients with cutaneous vasculitis includes detailed history, clinical examination and investigations to rule out multisystem involvement followed by skin biopsy and DIF at appropriate stage of evolution of lesions. Follow up of these patients is very essential as cutaneous manifestations may be the forme fruste of serious systemic involvement.
Gupta S, Handa S, Kanwar AJ et al. Cutaneous vasculitides: Clinico-pathological correlation. Indian J Dermatol Venereol Leprol. 2009;75:356-62.
Summa C, Hoffman C. Cutaneous vasculitis. J Am Osteopath Coll Dermatol. 2006;6:28-30.
Maunz G, Conzett T, Zimmerli W. Cutaneous vasculitis associated with fluoroquinolones. Infection. 2009;37:466-68.
Fiorentino DF. Cutaneous vasculitis. J Am Acad Dermatol. 2003;48:311-40.
Csernok E, Gross WL. Primary vasculitides and vasculitis confined to skin: clinical features and new pathogenic aspects. Arch Dermatol Res. 2000;292:427-36.
Luqmani RA. Disease assessment in systemic vasculitis. J Indian Rheumatol Assoc. 2003;11:35-44.
Gamarra AI, Metteson EL, Restrepo JF. Small vessel vasculitis: History, classification, etiology, histopathology, clinic, diagnosis and treatment. Colomb Rheumatol. 2001;24:187-205.
Chen KR, Carlson JA. Clinical approach to cutaneous vasculitis: Treatment. Am J Clin Dermatol. 2008;9:71-92.
Leelavathi M, Aziz SA, Gangaram H B et al. Cutaneous vasculitis: A review of aetiology and clinical manifestations in 85 patients in Malaysia. Med J Malaysia. 2009;64:210-2.
Sais G, Vidaller A, Jucgla A et al. Prognostic factors in leukocytoclastic vasculitis: a clinicopathologic study of 160 patients. Arch Dermatol. 1998;134:309-15.
Alexander B, Rameshkumar K, Layaseelan E. Cutaneous Vasculitis - A dynamic process posing diagnostic challenge. JAPI. 2003;51:574-7.