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Hypersensitivity vasculitis

Cutaneous small vessel vasculitis; Allergic vasculitis; Leukocytoclastic vasculitis

 

Hypersensitivity vasculitis is an extreme reaction to a drug, infection, or foreign substance. It leads to inflammation and damage to blood vessels, mainly in 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.

 

Symptoms

 

Symptoms may include:

  • New rash with tender, purple or brownish-red spots over large areas
  • Skin sores mostly located on the legs, buttocks, or trunk
  • Blisters on the skin
  • Hives (urticaria), may last longer than 24 hours
  • Open sores with dead tissue (necrotic ulcers)

 

Exams and Tests

 

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.

 

Outlook (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

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of hypersensitivity vasculitis.

 

Prevention

 

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

 

 

References

Habif TP. Hypersensitivity syndromes and vasculitis. In: Habif TP, ed. Clinical Dermatology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 18.

Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65(1):1-11. PMID: 23045170 www.ncbi.nlm.nih.gov/pubmed/23045170.

Patterson JW. The vasculopathic reaction pattern. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 8.

Stone JH. The systemic vasculitides. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 270.

Text only

 
  • Vasculitis on the palm

    Vasculitis on the palm - illustration

    These spots of blood under the skin, called purpura, are caused by vasculitis. They do not turn white with pressure (non-blanchable). In this particular case, the purpura are associated with an underlying disorder affecting the structure of the blood vessel walls called collagen-vascular disorder.

    Vasculitis on the palm

    illustration

  • Vasculitis

    Vasculitis - illustration

    Inflammation of the blood vessels (vasculitis) may be caused when antibodies that have attached to antigens in the blood (immune complexes), attach to the blood vessel walls. These purplish spots can be felt in the skin. They do not turn white (blanch) when pressed. As the condition progresses, they may become larger and more bruise-like (ecchymotic), and some may develop central ulceration or necrosis (tissue death).

    Vasculitis

    illustration

  • Vasculitis, urticarial on the hand

    Vasculitis, urticarial on the hand - illustration

    These red (erythematous), hive-like (urticarial) spots (plaques) are caused by inflammation of the blood vessels (urticarial vasculitis) and do not change over a 24-hour period. They may or my not turn white (blanch) with pressure.

    Vasculitis, urticarial on the hand

    illustration

    • Vasculitis on the palm

      Vasculitis on the palm - illustration

      These spots of blood under the skin, called purpura, are caused by vasculitis. They do not turn white with pressure (non-blanchable). In this particular case, the purpura are associated with an underlying disorder affecting the structure of the blood vessel walls called collagen-vascular disorder.

      Vasculitis on the palm

      illustration

    • Vasculitis

      Vasculitis - illustration

      Inflammation of the blood vessels (vasculitis) may be caused when antibodies that have attached to antigens in the blood (immune complexes), attach to the blood vessel walls. These purplish spots can be felt in the skin. They do not turn white (blanch) when pressed. As the condition progresses, they may become larger and more bruise-like (ecchymotic), and some may develop central ulceration or necrosis (tissue death).

      Vasculitis

      illustration

    • Vasculitis, urticarial on the hand

      Vasculitis, urticarial on the hand - illustration

      These red (erythematous), hive-like (urticarial) spots (plaques) are caused by inflammation of the blood vessels (urticarial vasculitis) and do not change over a 24-hour period. They may or my not turn white (blanch) with pressure.

      Vasculitis, urticarial on the hand

      illustration

    Tests for Hypersensitivity vasculitis

     
       

      Review Date: 4/24/2017

      Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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