Evaluation of adults with cutaneous lesions of vasculitis
- Nicole Fett, MD
Nicole Fett, MD
- Associate Professor
- Oregon Health and Science University
Cutaneous vasculitis can occur as a consequence of multiple disorders and is characterized by a wide variety of clinical findings. Because other diseases may present with similar clinical features, histopathologic examination is essential for confirming the diagnosis.
Patients with vasculitis are at risk for vasculitis involving other organs. In addition, the cause of cutaneous vasculitis is not always immediately clear. The performance of a thorough patient history and physical examination will guide the selection of the appropriate laboratory and radiologic studies for patient evaluation.
The clinical, histopathologic, and laboratory assessment of adults with cutaneous lesions suspicious for vasculitis will be reviewed here. The assessment of childhood vasculitis, the assessment of patients with retiform purpura, and detailed information on specific types of cutaneous vasculitis are discussed elsewhere. (See "Vasculitis in children: Evaluation" and "Approach to the patient with retiform (angulated) purpura" and "Overview of and approach to the vasculitides in adults" and "Management of adults with idiopathic cutaneous small vessel vasculitis".)
Cutaneous vasculitis results from inflammation of the small or medium-sized blood vessels in the skin. Small blood vessels are capillaries, post-capillary venules, and non-muscular arterioles in the superficial and mid-dermis (<50 micrometers). Medium-sized vessels consist of 50 to 150 micrometer vessels with muscular walls in the deep dermis and subcutis [1-5].
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- CUTANEOUS FINDINGS
- Common features
- Differential diagnosis
- CLINICAL ASSESSMENT
- Diagnostic criteria
- Type of biopsy
- Direct immunofluorescence studies
- - Value
- - Obtaining the specimen
- ADDITIONAL STUDIES
- Initial studies
- Secondary studies
- - Patients with pulmonary symptoms
- - Evaluation for malignancy
- - Evaluation for vasculitis due to levamisole-contaminated cocaine
- SUMMARY AND RECOMMENDATIONS