Clinical Analysis of Different Causes of Cutaneous Vasculitis

Abstract

Background: Cutaneous vasculitis is common in clinical practice and leukocytoclastic vasculitis is the most common feature of histopathological findings. Possible factors triggering cutaneous vasculitis include drug exposure, physical factors, autoimmune diseases, malignancies and infections. This study was undertaken to examine our collected cases of cutaneous vasculitis by comparing the clinical features and to attempt to define different etiologies of cutaneous vasculitis. Method: This study retrospectively reviewed the medical records of patients with skin biopsy proven cutaneous vasculitis at Chang Gung Memorial Hospital from January 1987 to April 2006. A total of 368 biopsy specimens were obtained, including 219 biopsies performed using direct immunofluorescence study simultaneously. According to the underlying causes, these patients were divided into four major categories: infection, drugs or food, ”other” (autoimmune diseases and malignancies), and idiopathic. The various groups were compared to identify differences in age, gender, underlying diseases, associated symptoms, abnormal blood and serological tests, and direct immunofluorescence study. Results: Regarding the triggers, in 81 (22%) patients the trigger was infection, in 51 (13.9%) patients it was associated with drugs or food, ”other” identifiable causes accounted for 39 (10.6%) patients and in the remaining 193 (52.4%) patients the trigger was not identified. Old age, underlying diseases, anemia, fever and sore throat were the most significant associated factors for cutaneous vasculitis resulting from infection. Anemia was more frequently seen in infection and autoimmune associated cutaneous vasculitis but less often in drug induced cutaneous vasculitis. IgA plus C3 deposition occurred in over 36.2% of infection associated cutaneous vasculitis compared to 32.1% of drugs/food and 7.1% of ”other” cutaneous vasculitis. Conclusions: The most common cause of cutaneous vasculitis was idiopathic. Clinically specific characteristics and immunopathological findings are useful for distinguishing possible causative factors.