Cutaneous Manifestations and Comorbidities in 60 Cases of Takayasu Arteritis

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To the Editor: Takayasu arteritis (TA) is a rare chronic vascular inflammatory disease that affects predominantly the aorta and its main branches, in addition to coronary arteries and pulmonary arteries. TA mainly affects young women, especially in the second and third decades of life; it has a high prevalence in Asian countries. The true incidence and prevalence of TA is probably underestimated and many patients remain undiagnosed or wait a long time before the correct diagnosis is made1. TA is typically presented in 2 stages: a “prepulseless” stage and a “pulseless” stage. In the former there are malaise, fever, myalgias, arthralgias, and weight loss. In this stage it may be difficult to differentiate TA from other rheumatic and collagen diseases. In the second stage, complications related to large arterial stenosis and aneurysm formation predominate. The 2 stages may overlap or occur out of sequence. In both stages, cutaneous manifestations may be present, such as inflammatory nodules, erythema nodosum, and pyoderma gangrenosum-like ulcers, and more rarely, purpura2. Eventually, cutaneous manifestations may be present as an initial signal of TA3. We systematically reviewed 60 patients with TA as proposed by the 1990 American College of Rheumatology (ACR) classification4, further delineating the prevalence and cutaneous manifestations observed in these cases. Three patients with specific TA cutaneous manifestations are described in detail. Our study was a single-center transversal study. From March 2010 to April 2012, 87 consecutive patients with TA were followed at our service. All patients fulfilled at least 3 of the 6 ACR criteria for the classification of TA, as proposed by Arend, et al 4. All these patients were invited for our evaluation, and 60 showed up. A dermatologist in the dermatology department of our hospital examined these 60 patients. Medical data … Address correspondence to Dr. L. Rocha, Hospital das Clínicas da Faculdade de Medicina da USP – Dermatology, Av. Dr. Enéas de Carvalho, 500 São Paulo, São Paulo 05409-000, Brazil., E-mail: lilianrocha{at}me.com