What disorders cause perivascular dermatitis?

Disorders That Cause Perivascular Dermatitis

Perivascular dermatitis is a histopathological pattern seen in multiple inflammatory skin disorders, most commonly in allergic contact dermatitis, atopic dermatitis, and drug-induced reactions. 1

Common Causes of Perivascular Dermatitis

Contact Dermatitis

• Allergic Contact Dermatitis

  • Most frequent cause of perivascular dermatitis 1
  • Involves sensitization to specific allergens with resulting T cell-mediated immune response
  • Common allergens include:
    • Nickel (14.5% prevalence) 1
    • Fragrances (37% prevalence) 1
    • Cobalt (22% prevalence) 1
    • Neomycin and other topical antibiotics 1, 2
    • Preservatives in cosmetics and medications 1, 3
    • Metals in jewelry or hearing aids 1

• Irritant Contact Dermatitis

  • Accounts for 7-9% of perivascular dermatitis cases 1, 3
  • Subtypes include:
    • Subjective irritancy (stinging/smarting reactions without visible changes)
    • Acute irritant contact dermatitis (from strong irritants/caustic agents)
    • Chronic cumulative irritant dermatitis (from repeated exposure to weak irritants) 1

Atopic Dermatitis

• Accounts for 14-25% of perivascular dermatitis cases 3
• Characterized by perivascular infiltration of IgE, T lymphocytes, and mast cells 4
• Often begins in childhood with chronic pruritus 1
• Clinical features vary with disease stage (erythema, xerotic scaling, lichenification) 1

Drug-Related Causes

• Chemotherapy-Induced Reactions

  • Palmar-plantar erythrodysesthesia syndrome (PPES)
  • Histopathology shows variable capillary dilation, keratinocyte abnormalities, perivascular lymphohistiocytic infiltrates 1
  • Associated with 5-FU, capecitabine, doxorubicin, and other agents 1

• Targeted Cancer Therapy Reactions

  • VEGFR inhibitors and MEK inhibitors can cause hand-foot skin reactions 1
  • Histologically shows perivascular dermatitis pattern

Other Causes

• Seborrheic Dermatitis

  • Affects sebaceous areas including ears, scalp, central face 1
  • Presents with greasy yellowish scaling and inflammation
  • Associated with Malassezia yeast 1

• Perioral/Periorbital Dermatitis

  • Presents with papules and pustules around mouth or eyes 5, 6
  • Histopathology similar to rosacea with perivascular infiltrate 5
  • Often preceded by topical corticosteroid use 5

• Airborne Contact Dermatitis

  • Accounts for 2-10% of perivascular dermatitis cases 3
  • Caused by airborne allergens contacting exposed skin

• Systemic Contact Dermatitis

  • Occurs after systemic administration of a substance to which topical sensitization previously occurred 1

Histopathological Features

The hallmark histopathological finding in perivascular dermatitis is:

• Perivascular lymphohistiocytic infiltrates
• May include spongiosis and vesicle formation
• In chronic cases: hyperkeratosis, parakeratosis, and lichenification 1, 2

Risk Factors

Significant risk factors for developing perivascular dermatitis include:

• Female gender
• Age ≥40 years
• Atopic skin diathesis 3
• Occupational exposure to irritants or allergens 1

Diagnostic Approach

For suspected allergic contact dermatitis causing perivascular dermatitis:

• Patch testing is essential (sensitivity 60-80%) 1
• Test both standard allergen panels and patient's own products 3
• Consider patch testing when:
  • History suggests contact allergen exposure
  • Unusual distribution of lesions
  • Late-onset or sudden worsening
  • Resistance to standard therapies 1

Common Pitfalls

1. Misdiagnosis: Perivascular dermatitis pattern can be seen in multiple conditions and is often clinically indistinguishable without proper testing 1

2. Overlooking allergens: 12.5% of allergic periocular dermatitis cases are only identified by testing patient's own products 3

3. Corticosteroid-induced complications: Uncritical use of topical corticosteroids can cause or worsen perioral/periorbital dermatitis 5

4. Missing systemic causes: Some cases of generalized dermatitis with perivascular pattern may involve systemic allergen exposure 1

By identifying the specific cause of perivascular dermatitis through careful clinical evaluation and appropriate testing, targeted therapy can be implemented to effectively manage this condition and improve patient outcomes.