Comments and References
|He was started on prednisolone 30mg daily by another dermatologist
but the blood sugar level, as expected, increased. Moreover, the
patient became uneasy and restless. Fexofenadine 180mg daily together
with cetirizine 10mg daily couldn't control the symptoms.
Are you convinced this is urticarial vasculitis? The histology
is suggestive but the laboratory tests so far could not pin
point the underlying cause. Serology for ANA was negative. There
was no relevant drug history.Would adding dapsone 100mg daily
be helpful? What is the prognosis for this condition?
- Davis MDP, Daoud MS, Kirby B, Gibson LE, Rogers RS. Clinicopathologic
correlation of hypocomplementemic and normocomplementemic
urticarial vasculitis. J Am Acad Dermatol 1998;38:899-905.
Patients with HUV were more likely to be female, to have diffuse
neutrophilia on biopsy specimens stained with hematoxylin
and eosin, to have continuous strong granular deposition of
immunoreactants along the basement membrane zone on DIF, and
to have SLE than normocomplementemic patients. We submit that
HUV represents a subset of SLE with shared clinical, laboratory,
and immunologic features.
Comments from Members
Goh Chee Leok FRCP, Clinical Professor Of Dermatology,
National Skin Centre, Singapore
The history here is rather short- 1 month only
The skin lesions are urticarial and suggestive of urticarial
vasculitis if it really last for more than 24 hours.
I would wait for another 4 weeks to see if it persist and do
further investigations to exclude underlying malignancy or other
I would give him atarax 25-50 mg nocte in addition to the OM
doses of non sedative antihistamines. Dapsone is only useful
if there is leucocytoclastic infiltrates.
Victoria P Werth, M.D., Associate Professor of Dermatology,
University of Pennsylvania School of Medicine, Philadelphia,
It sounds like urticarial vasculitis is a real possibility,
and the path seems to support this. You should probably check
complements to make sure they aren't low (if low, then this
is more consistent with underlying SLE, although this is unlikely
given negative ANA). You could treat with either dapsone or
colchicine. I usually start with dapsone 50 mg/day and check
labs in a week (if G6PD is OK). I then increase by 25 mg/week,
rechecking labs to make sure Hb drops aren't too much (about
2 gm drop is OK). Colchicine is another possiblity. I don't
think you need prednisone in this situation. Good luck
Jag Bhawan MD, Professor of Dermatology and Pathology,
Boston University School of Medicine, Boston, Massachusetts,
It is hard to appreciate leucocytoclasia in these images. Some
extravasated red cells are seen. However, I think the findings
are consistent with urticarial vasculitis. It will be important
to make sure that he is not taking over the counter medications
and other herbal stuff. Best is to try to find the culprit by
process of elimination and history. Dapsone may be a good idea.
Since the patient is doing well otherwise, no need to aggressively
treat him.You may order RO and LA antibodies to rule out variant
of lupus erythematosus.
Yelva Lynfield MD, Cedarhurst, New York, USA
on April 17, 2004
Do hepatitis screen and stools for ova and parasites.
Youssef Farid MD, Cairo, Egypt on Apr 25,
The clinical history and the histology fit well with urticarial
vasculitis. Ask about drugs like potassium iodide, fluoxetine,
and NSAIDs. The oral corticosteroid is of value if there is
an associated hypocomplementemic state if not hydroxychloroquine
sulfate, dapsone, colchicine or pentoxifylline may be steroid-sparing
agents. The antihistaminics are only of value if there is an
association of angioedema with the urticarial lesion. So check
the complement level first and this will direct you to the correct
line of treatment.