Management of Cutaneous Vasculitis

Introduction

Cutaneous vasculitis results from inflammation of the small blood vessels in the skin. It presents with palpable purpura. Areas of purpura less than 5mm in size are called petechiae, those larger than 1 cm in size are ecchymoses. Cutaneous vasculitis can be idiopathic/primary or secondary to infection, drugs or disease.

See figure 1 for images of cutaneous vasculitis.

Investigations

Investigations are requested to check for any underlying cause and to determine whether there is involvement of internal organs.

An initial vasculitis screen includes:

  • FBC, ESR, U&Es, LFTs, HIV, hepatitis B and C serology, ASOT
  • ANA, ANCA, serum complement, protein electrophoresis and immunoglobulin
  • Blood pressure monitoring, urinalysis and urine protein creatinine ratio
  • CXR if symptoms suggest lung disease
  • MPO / PR3 for diagnosis and monitoring of ANCA associated vasculitis

Initial treatment

  • Remove / treat the trigger if any underlying cause is found
  • Rest and elevation of affect limb(s), if applicable
  • Simple analgesia for pain
  • Prescribe regular emollients twice daily. Examples include: Hydromol® ointment, Zerobase® cream, QV® cream, white soft paraffin 50% / liquid paraffin 50% ointment (avoid aqueous cream). Important prescribing points:
    • In general, ointments are preferred for dry skin but are poorly tolerated.
    • Creams are used on less dry skin and better tolerated.
  • Prescribe topical corticosteroids: clobetasol propionate 0.05% (Dermovate®) ointment once or twice daily to affected area(s) on trunk and limbs.
  • If bullous or ulcerated, oral prednisolone may be required
  • Referral on to Dermatology
  • Consider referral on to Renal if there is blood and protein on urine dipstick, abnormal renal function or elevated urine protein creatinine ratio

 

Guideline reviewed October 2023
Page updated November 2023



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