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Hypersensitivity vasculitis

Allergic vasculitis; Leukocytoclastic vasculitis; Cutaneous vasculitis

Hypersensitivity vasculitis is an extreme reaction to a drug, infection, or foreign substance. It leads to inflammation and damage to blood vessels, primarily in the skin.

Causes

Hypersensitivity vasculitis is caused by an allergic reaction to a drug or other foreign substance. It can also be a reaction to an infection. Most often it affects people older than age 15.

Often, the cause of the problem cannot be found even with a careful study of medical history.

Hypersensitivity vasculitis may look like necrotizing vasculitis, which can affect blood vessels throughout the body.

Symptoms

Symptoms may include:

  • New rash over large areas
  • Purple-colored spots and patches on the skin
  • Skin sores mostly located on the legs, buttocks, or trunk
  • Blisters on the skin
  • Hives (urticaria), may last longer than 24 hours
  • Open sores with dead tissue (necrotic ulcers)

Exams and Tests

The health care provider will base the diagnosis on symptoms. The provider will evaluate how your skin looks after you have taken certain medicines or are exposed to a foreign substance (antigen).

Results from an ESR test (erythrocyte sedimentation rate test) may be high.

Skin biopsy shows inflammation of the small blood vessels. You may also have other tests to detect this condition.

Treatment

The goal of treatment is to reduce inflammation.

Your provider may prescribe aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids to reduce inflammation of the blood vessels. (DO NOT give aspirin to children except as advised by your provider).

Your provider will tell you to stop taking medicines that could be causing this condition.

Outlook (Prognosis)

Hypersensitivity vasculitis most often goes away over time. The condition may come back in some people.

People with ongoing vasculitis should be checked for necrotizing vasculitis.

Possible Complications

Complications may include:

  • Lasting damage to the blood vessels or skin with scarring
  • Inflamed blood vessels affecting the internal organs

When to Contact a Medical Professional

Call your provider if you have symptoms of hypersensitivity vasculitis.

Prevention

DO NOT take medicines which have caused an allergic reaction in the past.

References

Stone JH. The systemic vasculitides. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 270.

Stone JH. Immune complex-mediated small vessel vasculitis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 91.

    • Vasculitis on the palm

      Vasculitis on the palm - illustration

      These spots of blood under the skin (purpura) are caused by vasculitis. They do not turn white with pressure (non-blanchable). In this particular case, the purpura are associated with an underlying disorder affecting the structure of the blood vessel walls (collagen-vascular disorder).

      Vasculitis on the palm

      illustration

    • Vasculitis

      Vasculitis - illustration

      Inflammation of the blood vessels (vasculitis) may be caused when antibodies that have attached to antigens in the blood (immune complexes), attach to the blood vessel walls. These purplish spots can be felt in the skin. They do not turn white (blanch) when pressed. As the condition progresses, they may become larger and more bruise-like (ecchymotic), and some may develop central ulceration or necrosis (tissue death).

      Vasculitis

      illustration

    • Vasculitis, urticarial on the hand

      Vasculitis, urticarial on the hand - illustration

      These red (erythematous), hive-like (urticarial) spots (plaques) are caused by inflammation of the blood vessels (urticarial vasculitis) and do not change over a 24-hour period. They may or my not turn white (blanch) with pressure.

      Vasculitis, urticarial on the hand

      illustration

      • Vasculitis on the palm

        Vasculitis on the palm - illustration

        These spots of blood under the skin (purpura) are caused by vasculitis. They do not turn white with pressure (non-blanchable). In this particular case, the purpura are associated with an underlying disorder affecting the structure of the blood vessel walls (collagen-vascular disorder).

        Vasculitis on the palm

        illustration

      • Vasculitis

        Vasculitis - illustration

        Inflammation of the blood vessels (vasculitis) may be caused when antibodies that have attached to antigens in the blood (immune complexes), attach to the blood vessel walls. These purplish spots can be felt in the skin. They do not turn white (blanch) when pressed. As the condition progresses, they may become larger and more bruise-like (ecchymotic), and some may develop central ulceration or necrosis (tissue death).

        Vasculitis

        illustration

      • Vasculitis, urticarial on the hand

        Vasculitis, urticarial on the hand - illustration

        These red (erythematous), hive-like (urticarial) spots (plaques) are caused by inflammation of the blood vessels (urticarial vasculitis) and do not change over a 24-hour period. They may or my not turn white (blanch) with pressure.

        Vasculitis, urticarial on the hand

        illustration

      Review Date: 4/28/2015

      Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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