Urticarial Vasculitis: Symptoms, Diagnosis, and Treatment

The skin has developed a large number of rashes, primarily on the joints and buttocks?

Hello Director Gao, since last Thursday when I forcefully dragged the floor, I started to develop numerous red rashes on my hands (which feel like broken capillaries).
The next evening, I unexpectedly discovered that not only my hands but also many areas on my feet and buttocks had developed widespread rashes.
I visited two clinics; one diagnosed it as "urticaria," while the other said it was "dyshidrotic eczema." On Sunday, I went to the emergency department at Tzu Chi Hospital in Taichung, where the doctor suspected "vasculitis" and administered an antihistamine and a steroid injection, which alleviated the condition somewhat.
On Monday, I consulted the immunology and rheumatology department at Tzu Chi Hospital, where the doctor only examined my hands and concluded it was "urticaria." However, on Tuesday (today), I noticed that "the number of rashes increases whenever I exert my hands and feet or sit for a long time." After researching online, I feel that my condition closely resembles "urticarial vasculitis." Could you please advise if this situation is indeed urticarial vasculitis? Should I seek further examination at another hospital? Thank you very much.

Xu, 40~49 year old female. Ask Date: 2016/05/03

Dr. Gao Jiankai reply Internal Medicine

Dear Miss Hsu,
Thank you for your email.
Urticaria and urticarial vasculitis are somewhat different conditions.
Generally, urticaria tends to have a stronger itching sensation, while vasculitis is characterized primarily by a stinging pain.
Additionally, some urticaria can occur in areas of pressure or friction, so this may not necessarily indicate a worsening condition; sometimes it is simply a part of the ongoing course of the illness.
Before considering further examinations, I suggest we first observe the response of the rash to treatment, especially since it has only been about a week since the rash appeared.
If the medication is effective, I recommend continuing to monitor the situation, as some cases of urticaria can have a longer duration, sometimes exceeding one to two weeks.
If you remain very concerned, you may want to consult a rheumatologist.
Please remember to take photographs of the rash during flare-ups to assist the physician in their evaluation.
Best regards,
Allergy, Immunology, and Rheumatology Department, Changhua Hospital, Ministry of Health and Welfare

Reply Date: 2016/05/03

More Info

Urticarial vasculitis is a condition characterized by the presence of hives (urticaria) that are associated with inflammation of the blood vessels (vasculitis). This condition can often be confused with regular urticaria, but it has distinct features and implications for diagnosis and treatment.

Symptoms
The symptoms of urticarial vasculitis can include:
- Red, raised welts: These can appear similar to hives but often last longer (more than 24 hours) and may be painful or tender.

- Skin discoloration: The affected areas may show signs of bruising or purpura, which are small purple spots caused by bleeding under the skin.

- Itching: While itching can occur, it may not be as intense as in typical hives.

- Systemic symptoms: Some patients may experience fever, malaise, or joint pain, indicating a more systemic involvement.

Diagnosis
Diagnosing urticarial vasculitis typically involves:
- Clinical evaluation: A thorough history and physical examination are crucial. The duration of the lesions, associated symptoms, and response to antihistamines can provide important clues.

- Skin biopsy: A biopsy of the affected skin can help confirm the diagnosis by showing signs of vasculitis and ruling out other conditions.

- Blood tests: These may be performed to check for underlying autoimmune diseases or infections that could be contributing to the symptoms.

In your case, the sudden onset of red rashes after physical exertion, along with the distribution of the lesions, raises the suspicion of urticarial vasculitis. The fact that the rash worsens with activity and prolonged sitting suggests a possible vascular component, which aligns with urticarial vasculitis rather than typical urticaria.

Treatment
Treatment for urticarial vasculitis may include:
- Antihistamines: These can help alleviate itching and reduce the rash.

- Corticosteroids: As you experienced, corticosteroids can be effective in reducing inflammation and controlling symptoms, especially during acute flares.

- Immunosuppressive agents: In cases where urticarial vasculitis is severe or resistant to treatment, medications that suppress the immune system may be necessary.

- Avoidance of triggers: Identifying and avoiding triggers, such as certain medications or foods, can help manage symptoms.

Next Steps
Given your symptoms and the initial assessments from healthcare providers, it would be prudent to follow up with a specialist in dermatology or immunology. They can provide a more comprehensive evaluation and may recommend further testing, such as a skin biopsy or blood tests, to confirm the diagnosis and rule out other conditions.

In summary, while your symptoms may suggest urticarial vasculitis, a definitive diagnosis requires further evaluation. It’s important to continue working closely with your healthcare providers to manage your symptoms effectively and to ensure that any underlying conditions are addressed. If your symptoms worsen or new symptoms develop, seeking immediate medical attention is advisable.

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