2nd July 2023

Cutaneous Vasculitis

A group of disorders resulting in inflamed blood vessels in the skin. There are many different causes and a wide variety of clinical presentations. It is thought that the inflammatory response in the blood vessel wall could be a result of:

• Direct injury from bacteria or viruses
• Indirect injury through activation of antibodies
• Indirect injury through activation of complement pathways

There are many different causes of cutaneous vasculitis, including infection, autoimmune conditions and vasculitides, medications, and malignancy. In some cases, it can be associated with systemic vasculitis. However, in many cases, there is no underlying cause, and the disease will be self-limiting.

It can be classified according to which type of blood vessel it affects, such as capillaries, small, medium, or large vessels; however, large vessel vasculitis very rarely results in cutaneous features. The main presenting feature of small vessel vasculitis is pigmented and often palpable purpura, whereas nodules and a rash known as livedo reticularis are more associated with medium vessel vasculitis.

Diagnosis is based on the clinical appearance but can be supported with a skin biopsy and blood tests to exclude other possible underlying causes. Treatment is through identification and removal of the underlying cause, including treatment of systemic vasculitis if it is a manifestation of a systemic disorder. Initial management of the rash when no underlying cause is identified is cold avoidance.