Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

446 Cutaneous Vasculitis

differential diagnosis

■Macular purpura can be seen in thrombocytopenia, Rocky Mountain

spotted fever, or hemorrhagic disorders

■Pustules may be seen in infections like disseminated gonorrhea and

bacterial or fungal endocarditis.

■Palpable purpura can be seen in embolic disorders, such as endo-

carditis, cholesterol emboli, and left atrial myxoma.

management

What to Do First

■assess presence of systemic disease, particularly gastrointestinal,

renal, or neurologic

■determine type of vasculitis, based on type of skin lesions, other

clinical findings, laboratory tests

General Measures

■Determine possible precipitating causes, such as drugs or infection,

underlying diseases.

specific therapy

Indications

■Type of therapy is determined by the extent of skin disease, the type

of vasculitis, and involvement of other organs

Treatment Options

■Skin Disease only

➣Mild Disease

Colchicine:Periodically check CBC.

Dapsone:Check G6PD at baseline. Recheck CBC, hepatic func-

tion panel every week as dapsone dose is increased.

Consider combination of Colchicine and dapsone

➣Moderate to severe (extensive skin lesions±systemic involve-

ment)

Prednisone:Short course

Methotrexate: This is especially helpful for cutaneous pol-

yarteritis nodosa.

Azathioprine: Used as glucocorticoid-sparing agent in

patients requiring long-term steroids

Cyclophosphamide:Used as glucocorticoid-sparing agent in

severe disease, certain types of vasculitis (e.g., Wegener’s), and

severe disease refractory to other therapies

Intravenous immunoglobulin:severe disease