Cutaneous vasculitis--a dynamic process posing diagnostic challenge.

ABSTRACT

AIM: To characterize the clinicopathologic features and to assess the therapeutic outcome in cutaneous vasculitis. MATERIAL AND METHODS: Fifty biopsy proven cases of cutaneous vasculitis seen between January 1998 and July 1999 were studied. RESULTS: The commonest presentation was palpable purpura. The site most commonly affected was the extremity, irrespective of the age (adults - 40 and children - 10) and sex. The histopathologic picture ranged from an acute to chronic process, which besides the classic picture included bullous presentation, granulomatous histology and nonspecific features. Clinical correlation and investigations including direct immunofluorescence (DIF) were required to differentiate primary from secondary vasculitis (SLE-4, dermatomyositis-2, rheumatoid artritis-1, HIV-1, septicaemia-1 and drug reaction 2). DIF was diagnostic in 13 out of 21 cases providing evidence of an immune-mediated pathogenesis. Drugs used in the treatment included dapsone, colchicine, pentoxyphiline and steroids. CONCLUSIONS: The clinical picture and outcome of primary cutaneous vasculitis were benign while the prognosis of secondary vasculitis depended on the primary disease, irrespective of the histopathological picture.