DermatopathologyProlonged urticaria with purpura: The spectrum of clinical and histopathologic features in a prospective series of 22 patients exhibiting the clinical features of urticarial vasculitis
Section snippets
Methods
In this prospective study, patients were recruited during a 1-year period from the outpatient clinics of the National Skin Centre, a tertiary referral center for dermatologic conditions in Singapore. The study protocol was approved by the institutional review board.
Our inclusion criteria were persistent urticarial lesions individually lasting longer than 24 hours, associated with at least 2 of 3 of the following: pain or tenderness; purpura or dusky changes; and resolution with
Results
Clinically, all patients (100%) had urticarial papules and wheals of more than 24 hours duration (Table I). Eighteen (81.8%) had purpura associated with the lesions, and 18 (81.8%) had hyperpigmentation after resolution (Fig 1, Fig 2). Pain or tenderness was present in 10 patients (45.5%). The mean duration of illness before presentation was 21.3 weeks (Range: 2 to 156 weeks) (Table I). Symptom of itch was experienced in all patients. A burning sensation over the lesions was reported in 15
Discussion
Conventionally, the diagnosis of urticarial vasculitis is made when urticarial wheals and papules lasting longer than 24 hours show features of a leukocytoclastic vasculitis on histology, with evidence of endothelial cell damage, fibrin deposition, and a cellular infiltrate of neutrophils with or without leukocytoclasia and lymphocytes.2 However, patients who present with clinical features similar to urticarial vasculitis as illustrated in our study often do not show features of a
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In Urticarial Vasculitis, Long Disease Duration, High Symptom Burden, and High Need for Therapy Are Linked to Low Patient-Reported Quality of Life
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Our results show that the diagnostic delay in patients with UV was longer than that reported in patients with chronic spontaneous urticaria (median, 8.1 vs 4.7 months).22 The rates of postinflammatory hyperpigmentation of the skin in our study (92.0%) are comparable to those reported in some13,23,24 but not all studies (21.0%-35.0%).9,10,25 In line with a recent report (75.0%),11 we observed higher rates of angioedema in patients with UV than previously described (91.9% vs 22.0%-51.0%).8-10,13,25,26
Urticarial vasculitis: Clinical and laboratory findings with a particular emphasis on differential diagnosis
2022, Journal of Allergy and Clinical ImmunologyCitation Excerpt :In a cohort of 57 cases of HUV, angioedema was associated in half cases, purpura in one-third, and livedo in 14%.11,15 Angioedema appears to be more common in HUV than in NUV (Table I).6-25 The clinical course of UV is generally characterized by lesions persisting from 4 to 8 weeks, with resolution within 1 year in 30% to 40% of patients,55,56 very rarely lasting from months to years.55
Skin biopsies: their utility to allergists and immunologists
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2021, International Journal of Women's DermatologyCitation Excerpt :Clinicians should also realize that systemic therapy may influence histologic findings. Some reports suggest histology other than that described herein, but these other findings can be explained by lesions that are too early, too late, or influenced by systemic therapy (Kamyab et al., 2019; Lee et al., 2007). Although there are characteristic features to look for on histopathologic examination, patients will not necessarily demonstrate all these findings and among those who do, a substantial amount of variation can exist.
Skin Biopsy in Chronic Urticaria: When and Where and What to Look for?
2021, Actas Dermo-SifiliograficasDermatologic Aspects of Systemic Vasculitis
2019, Neurologic ClinicsCitation Excerpt :IgM deposition in blood vessels, circulating RF, and monoclonal production of IgM occur in CV and RA-related vasculitis. Hypersensitivity vasculitis due to adverse drug reactions manifests as superficial dermal neutrophilic or lymphocytic SVV on skin biopsy and represents approximately 20% of cases of cutaneous vasculitis.1,8–10 Tissue eosinophilia is a useful indicator of drug-induced cutaneous SVV.
Supported by a research grant from the National Medical Research Council (NMRC/EG/NSC/2004).
Conflicts of interest: None declared.
Reprints not available from the authors.