Background Cutaneous vasculitis (CV) includes a large and heterogeneous set of syndromes characterized by inflammation of the skin vessels. The most common clinical manifestation is palpable purpura with leukocytoclastic vasculitis in biopsy.
Objectives Our aim was to study clinical associations of a large series of patients with CV.
Methods Study of 817 consecutive and unselected patients with CV of the same university hospital. The diagnosis required histological confirmation except in obvious cases like Henoch-Schönlein Purpura (HSP) in childhood. Primary vasculitic syndromes were classified according to the classification of Chapel Hill (Jennette J et al. Arthritis Rheum 1994; 37:187). Secondary vasculitis were considered those due to malignancies, major infections and connective tissue diseases. The different clinical associations were studied according to different age groups, considering adults patients older than 20 years (Michel et al. J Rheumatol 1992; 19:721-8).
Results Of 817 patients (457 men/360 women), 459 were adults (mean age±SD, 55.3±17.5 years) and 358 children-young (mean age ± SD, 7.5 ± 4.2 years). Of the 358 children-young, 355 had primary VC: HSP (279 cases), cutaneous leukocytoclastic angiitis (CLA) (68) and urticarial vasculitis (8). Of the 459 adults, 369 had a primary CV: CLA (239), HSP(105), urticarial vasculitis (12) and mixed cryoglobulinemia (13 patients). The CV was a manifestation of a systemic necrotizing vasculitis in 13 adults; polyarteritis nodosa (3), microscopic polyangiitis (4), Wegener’s disease (3) and Churg-Strauss syndrome (3). In addition, the CV was secondary to other processes in 77 adults: connective tissue diseases (34), severe infection (25), neoplasia (18). There were only three children-young patients, who had a secondary CV, a major infection (2 cases) and a connective tissue disease (1 case). Patients in which the CV was secondary to systemic necrotizing vasculitis, connective, serious infections or malignancies had clinical and laboratory data suggestive of this underlying disease.
Conclusions CV in children in most cases (99.2%) is primary, usually HSP or CLA, and has a good prognosis. By contrast, in adults a 22.4% is due to malignancies, major infections, connective tissue diseases, systemic necrotizing vasculitis or cryoglobulinemic vasculitis. Therefore, clinical assotiations depends of age, being more serious in adults.
Acknowledgements This study was supported by grants from “Fondo de Investigaciones Sanitarias”
PI12/00193 (Spain). This work was also partially supported by RETICS Program,
RD08/0075 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest None Declared