From the Guidelines
Leucocytoclastic vasculitis should be treated with systemic corticosteroids combined with azathioprine in severe cutaneous cases unresponsive to first-line therapy, including dapsone, as suggested by the British Association of Dermatologists' guidelines 1. When managing leucocytoclastic vasculitis, it's crucial to consider the severity of the condition and the patient's response to initial treatments.
- For mild cases, symptomatic relief with non-steroidal anti-inflammatory drugs and antihistamines may suffice.
- Moderate cases often require oral corticosteroids like prednisone.
- Severe or recurrent cases may necessitate immunosuppressive agents, with azathioprine being considered for severe cutaneous leucocytoclastic vasculitis 1. Key aspects of treatment include:
- Removing triggering factors
- Providing symptomatic relief
- Monitoring complete blood count, liver, and kidney function during immunosuppressive therapy The pathophysiology of leucocytoclastic vasculitis involves immune complex deposition in vessel walls, leading to neutrophil infiltration and vessel damage, which is why systemic corticosteroids combined with azathioprine may be effective in severe cases 1.
From the Research
Definition and Clinical Presentation
- Leucocytoclastic vasculitis (LCV) is a histopathologic description of a common form of small vessel vasculitis (SVV) that can affect the skin and internal organs 2.
- The leading clinical presentation of LCV is palpable purpura, and the diagnosis relies on histopathological examination 2.
- LCV can be caused by several medications, infections, or malignancy, and is often associated with systemic diseases such as ANCA-associated vasculitides, connective tissue diseases, and cryoglobulinemic vasculitis 2.
Diagnosis and Workup
- When LCV is suspected, an extensive workup is usually necessary to determine whether the process is skin-limited or an expression of a systemic vasculitis or disease 2.
- A comprehensive history and detailed physical examination must be performed, along with laboratory tests such as platelet count, renal function, and urinalysis 2.
- Serological tests for hepatitis B and C viruses, autoantibodies, and complement fractions should also be part of the workup 2.
Treatment and Management
- The treatment of LCV is mainly focused on symptom management, and may include rest, low-dose corticosteroids, colchicine, or other unproven therapies if the disease is skin-limited 2.
- Topical dapsone may be a reasonable option for selected patients, particularly those who cannot tolerate systemic medications due to side effects or medical contraindications 3.
- Colchicine has been studied as a potential treatment for cutaneous leukocytoclastic vasculitis, but its efficacy is unclear, with some studies showing no significant therapeutic effect 4.
- In cases of severe systemic vasculitis, higher doses of corticosteroids or immunosuppressive agents may be required, depending on the severity of organ involvement and the underlying associated disease 2, 5.
Prognosis and Outcome
- The prognosis of LCV depends on the underlying cause and the severity of internal organ involvement 2, 6.
- If a medication is the cause of LCV, the prognosis is generally favorable, and discontinuation of the culprit drug is usually resolutive 2.
- In cases of systemic vasculitis, the prognosis is more variable and depends on the severity of organ involvement and the response to treatment 2, 6.