From the Guidelines
Dry erythematous vasculitis-appearing changes likely represent a cutaneous small vessel vasculitis, which requires prompt evaluation and treatment, as recommended by the most recent guidelines 1. Initial management should include discontinuation of potential triggering medications, application of mid-potency topical corticosteroids like triamcinolone 0.1% cream twice daily to affected areas, and oral antihistamines such as cetirizine 10mg daily for symptom relief. For more extensive or severe cases, a short course of oral prednisone starting at 0.5-1mg/kg/day with a gradual taper over 2-3 weeks may be necessary, as suggested by earlier guidelines 1. These skin changes typically present as palpable purpura, petechiae, or erythematous macules and papules, often on the lower extremities. The condition results from immune complex deposition in small blood vessels, leading to inflammation, vessel damage, and extravasation of red blood cells. Underlying causes should be investigated, including infections, medications, autoimmune disorders, and malignancies. Laboratory evaluation should include complete blood count, urinalysis, renal function tests, and possibly skin biopsy for definitive diagnosis, as recommended by the KDIGO 2024 clinical practice guideline 1. If symptoms worsen or fail to improve within 1-2 weeks of treatment, referral to dermatology or rheumatology is recommended. It is essential to note that the management of large vessel vasculitis, as discussed in other guidelines 1, may differ from the approach to small vessel vasculitis. However, the most recent and highest-quality study 1 should be prioritized when making treatment decisions to optimize patient outcomes in terms of morbidity, mortality, and quality of life. Key considerations in the management of dry erythematous vasculitis-appearing changes include:
- Prompt evaluation and treatment to prevent complications
- Discontinuation of potential triggering medications
- Use of topical corticosteroids and oral antihistamines for symptom relief
- Consideration of oral prednisone for more extensive or severe cases
- Investigation of underlying causes, including infections, medications, autoimmune disorders, and malignancies
- Laboratory evaluation, including complete blood count, urinalysis, renal function tests, and possibly skin biopsy
- Referral to dermatology or rheumatology if symptoms worsen or fail to improve within 1-2 weeks of treatment.
From the Research
Dry Erythematous Vasculitis
- Dry erythematous vasculitis is a condition characterized by inflammation of the blood vessels, which can lead to a range of symptoms including skin lesions and ulcers 2.
- The diagnosis of vasculitis relies on histopathological and immunofluorescence studies, as well as a thorough history, review of systems, and physical examination 2.
- Vasculitis can be classified according to the size of the vessel involved, with small, medium, and large vessel vasculitis being the main categories 2, 3.
Clinical Presentation
- The clinical presentation of vasculitis can vary depending on the size of the vessel involved and the organs affected, but common symptoms include palpable purpura on the lower extremities 2.
- Systemic vasculitis can be a challenge to differentiate from other forms of vasculopathy, and clinicians should strive for high diagnostic certainty 4.
- A multidisciplinary approach can be used to raise diagnostic certainty in cases with large- and/or medium-vessel involvement 4.
Treatment
- Treatment for systemic vasculitis should be coordinated with an experienced rheumatologist and may involve immunosuppressive therapies such as cyclophosphamide and prednisone 5, 3.
- Methotrexate may be considered as adjunctive therapy to glucocorticoid therapy in glucocorticoid-resistance or complications 6.
- The American College of Rheumatology/Vasculitis Foundation has published guidelines on the management of several forms of primary systemic vasculitides, including giant cell arteritis, Takayasu arteritis, and polyarteritis nodosa 3.