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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Kolkhir P, Grakhova M, Bonnekoh H, Krause K, Maurer M. Treatment of urticarial vasculitis: A systematic review. J Allergy Clin Immunol 2019; 143:458-466. [PMID: 30268388 DOI: 10.1016/j.jaci.2018.09.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/03/2018] [Accepted: 09/07/2018] [Indexed: 01/19/2023]
Abstract
Urticarial vasculitis (UV) is a difficult-to-treat condition characterized by long-lasting urticarial rashes and histopathologic findings of leukocytoclastic vasculitis. Treatment is dictated by the severity of skin and systemic involvement and the underlying systemic disease. This is a comprehensive systematic review of the efficacy of current UV treatment options. We searched for relevant studies in 7 databases, including MEDLINE, Scopus, and Web of Science. In total, 261 eligible studies and 789 unique patients with UV were included in the systematic review. Most patients with UV are adult women with chronic (≥6 weeks) and systemic disease. UV is mostly idiopathic but can be associated with drugs, malignancy, autoimmunity, and infections. It usually resolves with their withdrawal or cure. Corticosteroids are effective for the treatment of skin symptoms in more than 80% of patients with UV. However, their long-term administration can lead to potentially serious adverse effects. The addition of immunomodulatory or immunosuppressive agents often allows corticosteroid tapering and improves the efficacy of therapy. Biologicals, including omalizumab, as well as corticosteroids, cyclophosphamide, dapsone, mycophenolate mofetil, plasmapheresis, colchicine, hydroxychloroquine, intravenous immunoglobulin, nonsteroidal anti-inflammatory drugs, and cyclosporine, can be effective for both skin and systemic symptoms in patients with UV. H1-antihistamines, montelukast, danazol, H2-antihistamines, pentoxifylline, doxepin, and tranexamic acid are not effective in most patients with UV. As of yet, no drugs have been approved for UV, and management recommendations are based mostly on case reports and retrospective studies. Prospective studies investigating the effects of treatment on the signs and symptoms of UV are needed.
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Affiliation(s)
- Pavel Kolkhir
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin, Germany; I.M. Sechenov First Moscow State Medical University, Division of Immune-mediated skin diseases, Moscow, Russia
| | | | - Hanna Bonnekoh
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin, Germany
| | - Karoline Krause
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin, Germany
| | - Marcus Maurer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin, Germany.
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3
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Vázquez-Herrera NE, Sharma D, Aleid NM, Tosti A. Scalp Itch: A Systematic Review. Skin Appendage Disord 2018; 4:187-199. [PMID: 30197900 PMCID: PMC6120392 DOI: 10.1159/000484354] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 12/19/2022] Open
Abstract
Scalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients.
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Affiliation(s)
| | - Divya Sharma
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nouf Mohammed Aleid
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, FL, USA
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5
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Bodemer AA. Urticaria. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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7
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Tosoni C, Cinquini M. Diagnostic and Therapeutic Iter in Chronic Urticaria Patients. Int J Immunopathol Pharmacol 2016; 19:265-9. [PMID: 16831293 DOI: 10.1177/039463200601900203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe a diagnostic and therapeutic protocol for the management of chronic urticaria. It is derived from an extensive review of current literature, with a cost-effective evaluation of laboratory investigations and therapeutic approaches. Our protocol may not represent a cornerstone for chronic urticaria: much has in fact to be clarified on pathogenetic mechanisms and aetiological factors. Nevertheless, its application should be able, in our opinion, to identify what is useful or not in the everyday management of chronic urticaria patients.
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Affiliation(s)
- C Tosoni
- Servizio di Reumatologia, Allergologia e Immunologia Clinica, Spedali Civili Brescia, Piazzale Spedali Civili 1, 25100 Brescia, Italy.
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Kassim JM, Igali L, Levell NJ. A 14-year paraneoplastic rash: urticarial vasculitis and dermal binding bullous pemphigoid secondary to chronic lymphocytic leukaemia. Clin Exp Dermatol 2014; 40:391-4. [DOI: 10.1111/ced.12553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. M. Kassim
- Dermatology Department; Norfolk and Norwich University Hospital; Norwich UK
| | - L. Igali
- Department of Cellular Pathology; Norfolk and Norwich University Hospital; Norwich UK
| | - N. J. Levell
- Dermatology Department; Norfolk and Norwich University Hospital; Norwich UK
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Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
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10
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Yamazaki M, Sugai K, Kobayashi Y, Kaburagi Y, Murashita K, Saito N, Hitoshi N, Imagawa T, Tsukagoshi H, Kimura H. A case of hypocomplementaemic urticarial vasculitis in a child due to coxsackievirus type A9. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.000596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mayumi Yamazaki
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Kazuko Sugai
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Yoshinori Kobayashi
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Yoichi Kaburagi
- Department of Pediatrics, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Kazuaki Murashita
- Department of Plastic Surgery, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Norimitsu Saito
- Department of Dermatology, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Niino Hitoshi
- Department of Pathology, National Hospital Organization Yokohama Medical Center, 3‐60‐2 Harajyuku, Totsuka‐ku, Yokohama, 245‐8575, Japan
| | - Tomoyuki Imagawa
- Department of Pediatrics, Yokohama City University School of Medicine, 3‐9, Fukuura, Yokohama, 236‐0004, Japan
| | - Hiroyuki Tsukagoshi
- Gunma Prefectural Institute of Public Health and Environmental Sciences, 378, Kamioki‐cho, Maebashi, Gunma, 371‐0052, Japan
| | - Hirokazu Kimura
- National Institute of Infectious Disease, Infectious Disease Surveillance Center, 4‐7‐1, Gakuen, Musashimurayama, Tokyo 208‐0011, Japan
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Loricera J, Calvo-Río V, Mata C, Ortiz-Sanjuán F, González-López MA, Alvarez L, González-Vela MC, Armesto S, Fernández-Llaca H, Rueda-Gotor J, González-Gay MA, Blanco R. Urticarial vasculitis in northern Spain: clinical study of 21 cases. Medicine (Baltimore) 2014; 93:53-60. [PMID: 24378743 PMCID: PMC4616327 DOI: 10.1097/md.0000000000000013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Urticarial vasculitis (UV) is a subset of cutaneous vasculitis (CV), characterized clinically by urticarial skin lesions of more than 24 hours' duration and histologically by leukocytoclastic vasculitis. We assessed the frequency, clinical features, treatment, and outcome of a series of patients with UV. We conducted a retrospective study of patients with UV included in a large series of unselected patients with CV from a university hospital. Of 766 patients with CV, UV was diagnosed in 21 (2.7%; 9 male and 12 female patients; median age, 35 yr; range, 1-78 yr; interquartile range, 5-54 yr). Eight of the 21 cases were aged younger than 20 years old. Potential precipitating factors were upper respiratory tract infections and drugs (penicillin) (n = 4; in all cases in patients aged <20 yr), human immunodeficiency virus (HIV) infection (n = 1), and malignancy (n = 1). Besides urticarial lesions, other features such as palpable purpura (n = 7), arthralgia and/or arthritis (n = 13), abdominal pain (n = 2), nephropathy (n = 2), and peripheral neuropathy (n = 1) were observed. Hypocomplementemia (low C4) with low C1q was disclosed in 2 patients. Other abnormal laboratory findings were leukocytosis (n = 7), increased erythrocyte sedimentation rate (n = 6), anemia (n = 4), and antinuclear antibody positivity (n = 2). Treatment included corticosteroids (n = 12), antihistaminic drugs (n = 6), chloroquine (n = 4), nonsteroidal antiinflammatory drugs (n = 3), colchicine (n = 2), and azathioprine (n = 1). After a median follow-up of 10 months (interquartile range, 2-38 mo) recurrences were observed in 4 patients. Apart from 1 patient who died because of an underlying malignancy, the outcome was good with full recovery in the remaining patients. In conclusion, our results indicate that UV is rare but not exceptional. In children UV is often preceded by an upper respiratory tract infection. Urticarial lesions and joint manifestations are the most frequent clinical manifestation. Low complement serum levels are observed in a minority of cases. The prognosis is generally good, but depends on the underlying disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Miguel A. González-Gay
- From Divisions of Rheumatology (JL, VC-R, CM, FO-S, JR-G, MAG-G, RB), Dermatology (MAG-L, SA, HF-L), Pediatrics (LA), and Pathology (MCG-V), Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain
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12
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Al Mosawi ZSA, Al Hermi BEA. Hypocomplementemic Urticarial Vasculitis Syndrome in an 8-year-old Boy: A Case Report and Review of Literature. Oman Med J 2013; 28:275-7. [PMID: 23904922 DOI: 10.5001/omj.2013.76] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/30/2013] [Indexed: 11/03/2022] Open
Abstract
Hypocomplementemic urticarial vasculitis syndrome is an immune complex-mediated disease of unknown etiology. The clinical course is characterized by urticaria, conjunctivitis, joint pain, and hypocomplementemia. We here report a case of a child with hypocomplementemic urticarial vasculitis syndrome that progressed to nephritis. Renal biopsy was consistent with diffuse proliferative glomerulonephritis with diffuse subendothelial immune deposits. He responded well to a combination of steroid and mofetil micofenolate.
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Kolkhir PV, Olisova OY, Kochergin NG. Hypocomplementemic urticarial vasculitis syndrome at the onset of systemic lupus erythematosus. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Different autoimmune diseases can result in urticarial eruptions, in particular, in the form of such a rare immune disorder as hypocomplementemic urticarial vasculitis syndrome (HUVS). HUVS can be the debut of diffuse connective tissue disorders, in particular, systemic lupus erythematosus (SLE). To optimize the diagnostics of this syndrome, the authors describe the course of HUVS in a female patient aged 31 suffering from SLE and characterize particular features of the differential diagnostics of HUVS with skin disorders, in the first place, chronic urticaria. The syndrome is diagnosed clinically and confirmed by histology and laboratory examinations. In addition to urticarial eruptions, HUVS is also characterized by the severe course with systemic manifestations on the part of different organs, reduction in the level of the complimentary components in the serum and detection of specific markers of the disease such as anti-C1q antibodies.
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Marzano AV, Vezzoli P, Berti E. Skin involvement in cutaneous and systemic vasculitis. Autoimmun Rev 2013; 12:467-76. [PMID: 22959234 DOI: 10.1016/j.autrev.2012.08.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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15
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Urticaria. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Urticarial Vasculitis: A Unique Presentation. South Med J 2009; 102:531-3. [DOI: 10.1097/smj.0b013e3181a0ae4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Dincy CVP, George R, Jacob M, Mathai E, Pulimood S, Eapen EP. Clinicopathologic profile of normocomplementemic and hypocomplementemic urticarial vasculitis: a study from South India. J Eur Acad Dermatol Venereol 2008; 22:789-94. [PMID: 18331318 DOI: 10.1111/j.1468-3083.2007.02641.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aims to study the clinical and histopathological characteristics of hypocomplementemic and normocomplementemic urticarial vasculitis (HUVS and NUV) among dermatology clinic attendees in a tertiary care hospital in South India. PATIENTS AND METHODS A prospective study was conducted in the dermatology department from February 2003 to May 2004. Seventy-five patients met the inclusion criteria for UV. Sixty-eight patients in whom complement levels were available were classified into either NUV or HUVS groups. Clinical features, laboratory parameters and histological features were compared, and the significance of differences was established using Pearson's Chi-squared test. RESULTS There was a female preponderance among patients with HUVS. Wheals > 24 h were seen in 90% of patients, and in 54.4% of patients, the wheals were partially blanching or non-blanching. Angioedema was more prevalent in patients with NUV than HUVS (44.4% vs. 21.4%). Systemic involvement was seen in 64.3% of patients with HUVS and 44.4% of patients with NUV. Fever, ANA positivity and systemic lupus erythematosus (SLE) were significantly associated with HUVS. In most cases of UV, a provoking factor could not be identified. Neutrophilic small vessel vasculitis was seen in 42.9% of patients with HUVS and 16.6% patients with NUV. Direct immunofluorescence test showing immunoreactants at the dermo-epidermal junction were present in 60% of patients with HUVS and 33.3% patients with NUV. CONCLUSION The clinical features of Indian patients with UV were similar to those reported from the West. Fever, ANA positivity and SLE were significantly associated with HUVS.
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Affiliation(s)
- C V P Dincy
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India.
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Other Allergic Skin Disorders. PEDIATRIC ALLERGY, ASTHMA AND IMMUNOLOGY 2008. [PMCID: PMC7119998 DOI: 10.1007/978-3-540-33395-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this chapter we discuss allergic skin disorders other than atopic dermatitis (AD): the urticaria-angioedema syndrome, allergic contact dermatitis (ACD), protein contact dermatitis (PCD), phytodermatitis, allergic photodermatitis and allergic vasculitis.
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Bodemer AA. Urticaria. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Davis MDP, Brewer JD. Urticarial vasculitis and hypocomplementemic urticarial vasculitis syndrome. Immunol Allergy Clin North Am 2004; 24:183-213, vi. [PMID: 15120147 DOI: 10.1016/j.iac.2004.01.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urticarial vasculitis is a clinicopathologic entity in which episodes of urticaria are accompanied by histopathologic features of cutaneous vasculitis. The histopathologic definition of vasculitis varies from report to report. In this article, vasculitis is defined as histopathologic features of blood vessel damage: There should be evidence of leukocytoclasis and vessel wall destruction, which may or may not be accompanied by fibrinoid deposits. Red blood cell extravasation and perivascular inflammatory cell infiltrate also may be present. The extent to which each of these elements must be present has been debated.
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Affiliation(s)
- Mark D P Davis
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55095, USA.
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Saigal K, Valencia IC, Cohen J, Kerdel FA. Hypocomplementemic urticarial vasculitis with angioedema, a rare presentation of systemic lupus erythematosus: rapid response to rituximab. J Am Acad Dermatol 2003; 49:S283-5. [PMID: 14576655 DOI: 10.1016/s0190-9622(03)00744-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of hypocomplementemic urticarial vasculitis and recurrent angioedema in a patient with systemic lupus erythematosus unresponsive to mycophenolate mofetil, high-dose methylprednisolone, and intravenous immunoglobulin that responded rapidly to rituximab. Rituximab is a monoclonal antibody against CD20 transmembrane protein on the surface of mature and malignant B cells. No adverse effects occurred during or after therapy, and the patient was discharged from the hospital for outpatient rituximab infusion and follow-up care.
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MESH Headings
- Adult
- Angioedema/etiology
- Angioedema/pathology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Back
- Diagnosis, Differential
- Facial Dermatoses/etiology
- Facial Dermatoses/pathology
- Humans
- Infusions, Intravenous
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/pathology
- Male
- Rituximab
- Vasculitis/etiology
- Vasculitis/pathology
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Affiliation(s)
- Kapil Saigal
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida, USA
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22
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Affiliation(s)
- A K Black
- St. John's Institute of Dermatology, King's Medical School, St. Thomas Hospital, London, UK
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23
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Tanaka H, Waga S, Kakizaki Y, Sugimoto K, Nomura K, Yokoyama M. Chronic urticaria associated with aseptic meningitis: an atypical urticarial vasculitis? ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1997; 39:64-8. [PMID: 9124057 DOI: 10.1111/j.1442-200x.1997.tb03558.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The patient was a 7-year-old girl with early onset urticarial cutaneous lesions and was later complicated with aseptic meningitis. Her skin lesions occurred in the infantile period and were diagnosed as urticaria, but did not disappear with antihistamines and were recurrent and persistent. In addition, she had experienced an episode of headache about once a month since 1991, when she was 4 years old, and was diagnosed as aseptic meningitis. All studies including skin biopsy for urticarial vasculitis (UV) and systemic lupus erythematosus (SLE) were negative except for the data from non-specific inflammations. A systemic corticosteroid therapy dramatically reduced her symptoms. An unusual clinical course for this patient is described. It might suggest that this case is a presentation of the disease entity of UV, chronic urticaria and possibly SLE. To our knowledge, a similar case has not been previously reported.
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Affiliation(s)
- H Tanaka
- Department of Pediatrics, Hirosaki University School of Medicine, Japan
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25
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Kanazawa K, Yaoita H, Tsuda F, Okamoto H. Hepatitis C virus infection in patients with urticaria. J Am Acad Dermatol 1996; 35:195-8. [PMID: 8708019 DOI: 10.1016/s0190-9622(96)90322-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection induces variable skin manifestations. OBJECTIVE Our purpose was to determine whether there is an association between HCV infection and urticaria. METHODS Antibody to HCV (anti-HCV) and HCV genotypes were determined in patients with urticaria and in a control population. RESULTS Anti-HCV was detected in 19 (24%) of 79 patients with urticaria, and HCV RNA was detected in 17 (22%). Genotypes of HCV were II/1b in 12 (71%), III/2a in 4 (24%), and IV/2b in 1 (6%). The 17 patients with HCV RNA were older (53 +/- 14 vs 41 +/- 14 years, p < 0.01), and their eruption lasted longer (35% vs 6%, p < 0.05) and left pigmentation more frequently (53% vs 3%, p < 0.001). They had higher levels of alanine aminotransferase (67 +/- 34 vs 25 +/- 17 U/L, p < 0.001), aspartate aminotransferase (51 +/- 23 vs 21 +/- 8 U/L, p < 0.001), zinc turbidity test (12.8 +/- 3.1 vs 9.3 +/- 3.7 Kunkel units, p < 0.001), and IgG (1919 +/- 320 vs 1622 +/- 349 mg/100 ml, p < 0.01) than the patients without HCV RNA. CONCLUSION HCV could be a significant cause of urticaria. Chronic urticaria associated with HCV infection has peculiar clinical, serologic, and biochemical characteristics that could make it a distinct clinical entity with an indication for interferon therapy.
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Affiliation(s)
- K Kanazawa
- Department of Dermatology, Jichi Medical School, Tochigi-Ken, Japan
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26
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Abstract
OBJECTIVE The objective of this review is to give the reader a global insight into the spectrum of urticaria, focusing on differential diagnosis and pathogenic mechanisms. This review will define the role of the mast cell, explore a possible autoimmune basis for urticaria, and examine the purported role of food allergy in chronic urticaria. Last, the work-up and treatment of urticaria will be discussed in the context of the histologic diagnosis. STUDY SELECTION The relevant past medical literature will be reviewed in the context of new and novel research into the mechanisms of chronic urticaria. RESULTS Urticaria can be classified histopathologically into the following three categories: (1) neutrophilic vasculitis, (2) polymorphous perivascular infiltrate, and (3) sparse perivascular lymphocytic infiltrate. Each of the above histologic patterns correlates with a distinct clinical entity and the work-up and treatment of urticaria will be related to each of the above histologic types. CONCLUSIONS Urticaria and angioedema are frustrating problems for both physicians and their patients; however, the problem can best be approached by considering urticaria as a symptom that may be part of a larger clinical spectrum. The physical examination and medical history remain the two most important pieces of information. The allergist frequently overlooks the value of a skin biopsy as an aid in sorting out the pathophysiology of urticaria and the biopsy results may help to classify urticaria into subgroups which respond differently to treatment.
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Affiliation(s)
- E N Charlesworth
- Department of Allergy and Dermatology, Brenham Clinic Association, Texas, USA
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27
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28
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THE SPECTRUM OF URTICARIA. Immunol Allergy Clin North Am 1995. [DOI: 10.1016/s0889-8561(22)00810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Strickland DK, Ware RE. Urticarial vasculitis: an autoimmune disorder following therapy for Hodgkin's disease. MEDICAL AND PEDIATRIC ONCOLOGY 1995; 25:208-12. [PMID: 7623731 DOI: 10.1002/mpo.2950250309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immunological abnormalities have been described in patients with Hodgkin's disease, both associated with the malignancy itself and occurring secondary to therapy. These abnormalities often manifest as an immunodeficiency state, but can also present as immune dysregulation and autoimmune disease. We report two young patients with Hodgkin's disease who, following successful therapy, developed urticarial vasculitis (UV), a form of cutaneous autoimmune vasculitis. Both patients also had systemic symptoms including fever, an elevated erythrocyte sedimentation rate and serum copper, and abnormal in vitro studies of lymphocyte enumeration and proliferation. Distinguishing UV from recurrent Hodgkin's disease was especially difficult in one patient, and was possible only by lymph node biopsy. One patient has responded well to immunosuppressive therapy, while the other, who has more profound immune dysfunction, has developed a chronic autoimmune disorder. UV may thus occur in patients after therapy for Hodgkin's disease; we hypothesize that immune dysregulation, either associated with the malignancy or resulting from therapy, is important in the pathogenesis of this autoimmune process.
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Affiliation(s)
- D K Strickland
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
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30
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Abstract
Cutaneous involvement may occur with virtually all syndromes of vasculitis. This can occur primarily as a dermatologic disorder or as a manifestation of a potentially life threatening systemic vasculitis. In this review article, classification, clinical manifestations, pathogenesis and therapy of cutaneous vasculitis will be discussed. Disorders which are primarily vascular in origin but lack a well defined inflammatory phase, referred to as 'vasculopathies' will also be discussed.
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Affiliation(s)
- R I Kelly
- St Vincent's Hospital, Melbourne, Victoria, Australia
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31
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Lin RY, Caren CB, Menikoff H. Hypocomplementaemic urticarial vasculitis, interstitial lung disease and hepatitis C. Br J Dermatol 1995; 132:821-3. [PMID: 7772493 DOI: 10.1111/j.1365-2133.1995.tb00734.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 42-year-old man developed persistent urticaria and angio-oedema responsive to systemic steroids. A skin biopsy revealed leucocytoclastic vasculitis. C4 levels were consistently decreased in the setting of a mildly elevated erythrocyte sedimentation rate. Pulmonary function studies revealed a restrictive pattern, and there was eosinophilia in bronchial lavage fluid. Antibody to hepatitis C virus was positive, and there was mild elevation of serum aminotransferase. We believe that this case represents another possible manifestation of immunological disease associated with hepatitis C virus infection.
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Affiliation(s)
- R Y Lin
- St Vincent's Hospital, New York, NY 10011, USA
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32
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Abstract
A 32-year-old woman with a 6-year history of urticaria, acute anterior uveitis and mesangial glomerulonephritis developed bilateral pleural effusion. A thorough laboratory workup during repeated attacks of concomitant urticaria and bilateral pleural effusion together with the histopathological finding of the skin biopsy revealed normocomplementemic leukocytoclastic vasculitis. Bilateral pleural effusion should be included in the clinical spectrum of urticarial vasculitis syndrome.
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Affiliation(s)
- S O Paira
- Rheumatology Department, Hospital José M. Cullen, Santa Fe, Argentina
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33
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Affiliation(s)
- M V Dahl
- University of Minnesota Medical School, Minneapolis
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34
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Altus P, Blandon R, Wallach PM, Flannery MT. Case report: the spectrum of autoimmune thyroid disease with urticaria. Am J Med Sci 1993; 306:379-80. [PMID: 8266979 DOI: 10.1097/00000441-199312000-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Urticaria has many known etiologies. An association with autoimmune thyroid disease is described. One individual had the triad of urticaria, Hashimoto's thyroiditis, and rheumatoid arthritis, whereas the other individual had urticaria preceding Graves' disease by over 1 year.
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Affiliation(s)
- P Altus
- Department of Internal Medicine, University of South Florida, Tampa
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35
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Abstract
Urticaria and angioedema are usually the clinical consequence of vasoactive mediators derived from mast cells in the skin or mucosal tissues. Efforts to classify mast cell-mediated causes of urticaria and angioedema have generally been frustrated by their diverse pathogenesis and clinical course. The term acute is typically used to describe fleeting lesions whose recurrence does not extend beyond 6 weeks. Chronic is the term used to describe lesions that persist for more than a few hours but usually less than a day, and recurrences extend for more than 6 weeks. These definitions do not take histology into account. Skin biopsies of fleeting lesions demonstrate a paucity of inflammatory cells, whereas more persistent lesions display a spectrum of perivascular cuffing by predominantly T cells and monocytes. The presence of leukocytoclastic vasculitis in persistent lesions indicates an underlying immune complex disease. Many of the physical urticarias have fleeting lesions that can be induced with the appropriate stimulus for years. This review article has emphasized the clinical course and histology of urticaria and angioedema lesions in an effort to provide a more complete understanding of the pathogenesis and appropriate treatment. Clearly, avoidance of an identifiable inciting stimulus is optimum management, although most patients have no etiology defined or the cause is not realistically avoidable. At present, treatment options for these patients rely on antihistamines to control the immediate consequence of mast cell degranulation. Corticosteroids are reserved for the treatment of patients whose urticaria or angioedema lesions persist, reflecting the increasing involvement of mononuclear cells in the disease process. For leukocytoclastic vasculitis, corticosteroids are indicated, and cytotoxic drugs may be required for adequate treatment. Future treatments of urticaria and angioedema will evolve based on elucidation of the relevant cells and soluble mediators and will include counterregulatory or antagonistic peptides and drugs. C1 esterase inhibitor deficiency is a relatively uncommon cause of angioedema but is important to understand because of its ability to clinically mimic mast cell-mediated angioedemas and its unique pathogenesis and treatment. HAE can be divided into two serologic subtypes that simply reflect the location of the defect in one of the codominantly expressed C1-INH genes on chromosome 11. AAE can be divided into two serologic subtypes. AAE type I is due to massive consumption of C1-INH, presumably by tumor-related immune complexes. AAE type II is due to an anti-C1-INH autoantibody.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- D P Huston
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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36
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Mehregan DR, Hall MJ, Gibson LE. Urticarial vasculitis: a histopathologic and clinical review of 72 cases. J Am Acad Dermatol 1992; 26:441-8. [PMID: 1564151 DOI: 10.1016/0190-9622(92)70069-r] [Citation(s) in RCA: 217] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Urticarial vasculitis is a subset of vasculitis characterized clinically by urticarial skin lesions and histologically by necrotizing vasculitis. OBJECTIVE A review of patients with urticarial vasculitis was undertaken to further characterize the clinical and histologic findings and to differentiate this disorder from urticaria and other types of cutaneous vasculitis. METHODS Seventy-two cases of biopsy-proven urticarial vasculitis were selected for a review of medical records, laboratory data, and histologic findings. Fifty cases of simple urticaria were also reviewed for purposes of comparison. RESULTS Systemic symptoms in patients with urticarial vasculitis included angioedema in 30 patients (42%), arthralgias in 35 (49%), pulmonary disease in 15 (21%), and abdominal pain in 12 (17%). Twenty-three patients (32%) had hypocomplementemia. Forty-six of 72 patients (64%) had lesions that lasted more than 24 hours, 23 of 72 (32%) had painful or burning lesions, and 25 of 72 (35%) had lesions that resolved with purpura. Sixteen biopsy specimens from the 23 patients with hypocomplementemia showed dermal neutrophilia in addition to the perivascular infiltrate. Of the 23 patients with hypocomplementemia, 20 (87%) had fluorescence of the blood vessels and 16 (70%) had fluorescence of the basement membrane zone as determined by routine direct immunofluorescence. CONCLUSION Patients with hypocomplementemia were more likely to have systemic symptoms such as urticaria that resolved with purpura, arthralgias, abdominal pain, and chronic obstructive pulmonary disease. The histologic pattern associated with hypocomplementemia is interstitial neutrophilic infiltrate of the dermis and an immunofluorescent pattern of immunoglobulins or C3 in the blood vessels and along the basement membrane zone.
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Affiliation(s)
- D R Mehregan
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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37
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Asherson RA, Buchanan N, Kenwright S, Fletcher CM, Hughes GR. The normocomplementemic urticarial vasculitis syndrome--report of a case and response to colchicine. Clin Exp Dermatol 1991; 16:424-7. [PMID: 1806316 DOI: 10.1111/j.1365-2230.1991.tb01227.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A patient with a 15-year history of urticarial vasculitic rashes and chronic vasculitic skin ulceration has been followed at our Connective Tissue Disease Clinic for the past five years. Serum complement levels have been persistently normal. She has been unresponsive to a variety of medications including steroids, dapsone and hydroxychloroquine. She had a dramatic response to colchicine 500 micrograms daily with total clearing of the urticarial vasculitic rash.
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Affiliation(s)
- R A Asherson
- Department of Rheumatology, St Thomas' Hospital, London, UK
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38
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Asherson RA, D'Cruz D, Stephens CJ, McKee PH, Hughes GR. Urticarial vasculitis in a connective tissue disease clinic: patterns, presentations, and treatment. Semin Arthritis Rheum 1991; 20:285-96. [PMID: 2068575 DOI: 10.1016/0049-0172(91)90029-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Findings in 27 patients with typical skin lesions of urticarial vasculitis (UV) who were seen at a connective tissue disease clinic over a 5-year period (1986 to 1990) are reviewed. The majority suffered from systemic lupus erythematosus (SLE) or from "lupus-like" disease (18 patients), 1 from "mixed" connective tissue disease (MCTD), and 5 from primary UV. All of the latter patients had normal serum complement levels (normocomplementemic urticarial vasculitic syndrome; NUVS). No patients with hypocomplementemic UV were encountered. Two patients suffered from necrotizing vasculitis (polyarteritis nodosa, Wegener's granulomatosis); one had a C1-esterase inhibitor deficiency and also demonstrated an immunoglobulin G paraproteinemia. Angioedema occurred in many patients and could not be used as a differential diagnostic feature. The course of the illness was chronic in most patients, lasting for up to 23 years, and the response to therapy was unpredictable, erratic, and unsustained. The use of intravenous "pulse" methylprednisolone, cyclophosphamide, or high-dose oral steroids helped selected patients. Colchicine was dramatically effective in one patient with NUVS of 15 years duration. Azathioprine was not beneficial. None of the five patients with NUVS suffered from severe systemic involvement or renal disease, confirming observations by others that this form of UV represents a milder example of the condition.
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Affiliation(s)
- R A Asherson
- Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London, England
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